著者

Yuichiro Fujieda Keita Ninagawa Yuichiro Matsui Michihiro Kono Tamotsu Kamishima Norimasa Iwasaki Tatsuya Atsumi

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.4671-20, (Released:2020-06-15)

参考文献数

13

被引用文献数

8

---

Infectious disease with various presentations in systemic lupus erythematosus (SLE) often resembles lupus flare. A 37-year-old woman presented with a swollen left index finger that had not resolved, despite 7 years of immunosuppressive treatment. MRI showed rice-body formation in the flexor tendon sheath and tenosynovectomy demonstrated chronic synovitis with epithelioid granuloma. A mycobacterial culture confirmed invasive mycobacterial tenosynovitis due to Mycobacterium chelonae. The patient was treated with moxifloxacin and clarithromycin and completely recovered.

著者

Kazuhiro Ota Ryosuke Yamaguchi Akihiro Tsukahara Shinya Nishida Taro Shigekiyo Satoshi Harada Yuichi Kojima Toshihisa Takeuchi Shigeki Arawaka Kazuhide Higuchi

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.4684-20, (Released:2020-05-23)

参考文献数

12

被引用文献数

9

---

A 68-year-old woman presented with a 2-year history of worsening unsteady gait. Her neurological examination revealed peripheral neuropathy with lower limb sensory dominance. T2-weighted imaging revealed a disorder of the posterior cervical cord. Blood test findings revealed vitamin B12 deficiency, and gastroscopy revealed typical findings of autoimmune gastritis. She received vitamin B12 supplementation, but some peripheral neuropathy symptoms persisted due to longstanding vitamin B12 deficiency. Asymptomatic patients should undergo gastroscopy to detect autoimmune gastritis, as chronic vitamin B12 deficiency causes irreversible peripheral neuropathy.

著者

Kenta Nonomura Katsumi Iizuka Yayoi Kuwabara-Ohmura Daisuke Yabe

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.4323-19, (Released:2020-03-19)

参考文献数

25

被引用文献数

4

---

A 72-year-old man had type 2 diabetes (T2D) that had been diagnosed at 54 years old. Macroalbuminuria was first detected at age 64. While his HbA1c had been kept below 7%, his estimated glomerular filtration rate (eGFR) was declining rapidly. At 70 years old, his eGFR dropped below 50 ml/min/1.73 m2. A renal biopsy revealed diabetic nephropathy. sodium glucose transporter 2 inhibitors (SGLT2i)/glucagon-like peptide-1 receptor agonists (GLP-1RA) combination therapy substantially improved his eGFR and urinary albumin level, and the renoprotective effect persisted for the two-year study period. These findings suggest that SGLT2i and GLP-1RA can additively improve the renal function in patients with T2D.

著者

Hiroyuki Yamaguchi Hiroyuki Kobayashi Kazuya Nagasaki

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.59, no.4, pp.595, 2020-02-15 (Released:2020-02-15)

参考文献数

1

被引用文献数

1

著者

Shiho Toyama Ayuko Takatani Tomohiro Koga Mizuna Eguchi Momoko Okamoto Sosuke Tsuji Yushiro Endo Toshimasa Shimizu Remi Sumiyoshi Takashi Igawa Shin-ya Kawashiri Naoki Iwamoto Kunihiro Ichinose Mami Tamai Hideki Nakamura Tomoki Origuchi Masako Furuyama Maiko Tabuchi Shinichiro Kobayashi Kengo Kanetaka Mikiko Hashisako Kuniko Abe Daisuke Niino Shinya Sato Yasushi Miyazaki Atsushi Kawakami

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.2782-19, (Released:2019-07-22)

参考文献数

20

被引用文献数

1

---

A 71-year-old woman being treated with methotrexate (MTX) and tacrolimus (TAC) for rheumatoid arthritis (RA) was admitted to our hospital and underwent surgery for gastric perforation and peritonitis. An endoscopic examination six days post-surgery showed an extensive ulcer in the stomach, and a biopsy revealed diffused large B-cell lymphoma. We diagnosed her with immunodeficiency-associated lymphoproliferative disorder (LPD) and discontinued the MTX and TAC. She underwent gastrectomy due to stenosis approximately two months after the first operation, but the histopathological findings of lymphoma had disappeared. LPD should be considered as a potential cause of gastric perforation during RA treatment.

著者

Eikan Mishima Hideki Ota Takehiro Suzuki Takafumi Toyohara Kazumasa Seiji Sadayoshi Ito Yoshikatsu Saiki Kei Takase Takaaki Abe

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.3855-19, (Released:2020-01-17)

参考文献数

21

---

We report a case in which diffusion-weighted magnetic resonance imaging (DWI) demonstrated renal artery stenosis-related renal ischemia and the therapeutic efficacy of revascularization. The patient was a 73-year-old man, who underwent descending thoracic aortic replacement due to DeBakey IIIb chronic aortic dissection, and who showed progressive renal dysfunction due to right renal artery stenosis caused by false lumen thrombosis. DWI demonstrated a decreased apparent diffusion coefficient (ADC) in the right kidney, indicating renal ischemia. Angioplasty with stenting restored renal perfusion and improved the renal function, resulting in the normalization of the decreased ADC in the treated kidney. Thus, DWI can be used to monitor renal ischemia in cases involving advanced renal artery stenosis.

著者

Yuji Kato Takeshi Hayashi Noriko Arai Norio Tanahashi Koichi Takahashi Masaki Takao

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.2587-18, (Released:2019-05-22)

参考文献数

10

被引用文献数

14

---

Postural tachycardia syndrome (POTS) can cause orthostatic headache. However, it is difficult to differentiate POTS from spontaneous intracranial hypotension (SIH) caused by cerebrospinal fluid (CSF) leaks. We herein report a 53-year-old woman who presented with SIH associated with POTS. A cervicothoracic and lumbar epidural blood patch rapidly improved not only the headache but also the orthostatic tachycardia, suggesting POTS secondary to SIH. This case suggests that a CSF leak can cause secondary POTS. Therefore, POTS should be considered in patients with orthostatic headaches, even in the presence of a CSF leak.

著者

Kiyotaka Nakamagoe Ayako Shioya Tetsuto Yamaguchi Hiroyuki Takahashi Reiko Koide Tatsuya Monzen Jun-ichi Satoh Akira Tamaoka

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.50, no.22, pp.2839-2844, 2011 (Released:2011-11-15)

参考文献数

19

被引用文献数

6 10

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A 38-year-old Japanese man with Nasu-Hakola disease (NHD) had repeated pathological fractures and frontal lobe symptoms which developed when he was 18 and 26 years old, respectively. Neuropsychological testing showed memory impairment, and in particular, visuo-spatial memory at the age of 35. Furthermore, single-photon emission computed tomography revealed precuneus hypoperfusion. The patient later suffered prolonged convulsive seizures, which left him in a persistent vegetative state. Genetic testing confirmed a heterozygous mutation in the DAP12 gene (a single-base deletion of 141 G in exon 3) specific to NHD. Precuneus dysfunction might contribute to characteristic memory impairment of NHD.

著者

Kazuo Tsuchiya Masato Karayama Taichi Sato Hideki Yasui Hironao Hozumi Yuzo Suzuki Kazuki Furuhashi Noriyuki Enomoto Tomoyuki Fujisawa Yutaro Nakamura Naoki Inui Haruhiko Sugimura Hideo Yasuda Takafumi Suda

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.3004-19, (Released:2019-07-22)

参考文献数

35

被引用文献数

7

---

A 71-year-old woman with abnormal pulmonary shadows and multiple enlarged thoracic lymph nodes was diagnosed with stage IIB lung adenocarcinoma, pulmonary sarcoidosis, and sarcoidosis-associated lymphadenopathy after biopsies from multiple organ sites. She also had rapidly progressive renal dysfunction, microhematuria, and high myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA) concentrations. A renal biopsy revealed granulomatous tubulointerstitial nephritis and necrotizing glomerulonephritis with crescent formation. She was diagnosed with nephritis caused by both sarcoidosis and ANCA-associated vasculitis. Oral prednisolone was administered to treat her nephritis, resulting in improvement in both her renal dysfunction and her sarcoidosis-associated lymphadenopathy.

著者

Antonietta Rizzo Marina Di Domenico Caterina Romano Carratelli Rossella Paolillo

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.51, no.1, pp.113-117, 2012 (Released:2012-01-01)

参考文献数

44

被引用文献数

18 20

---

Chlamydia trachomatis and Chlamydophila pneumoniae are human pathogens; the former being the etiologic agent for trachoma as well as a prevalent sexually transmitted bacterium, while C. pneumoniae is a respiratory pathogen responsible for community-acquired pneumonia. Patients with reactive arthritis show evidence of present or past Chlamydial infection. Chlamydia spp., has been strongly implicated as a triggering factor for reactive arthritis. We describe the simultaneous occurrence of C. pneumoniae and C. trachomatis infections in a subject with reactive arthritis. We suggest treatment for a patient with Chlamydia-associated arthritis to define a means by which persistent organisms can be induced to return to the active developmental cycle, thereby making them more accessible to antibiotic activity.

著者

Tetsuji Morishita Hiroyasu Uzui Hiroyuki Ikeda Naoki Amaya Kenichi Kaseno Kentaro Ishida Yoshitomo Fukuoka Hiroshi Tada

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.2616-19, (Released:2019-06-27)

参考文献数

39

被引用文献数

5

---

Objective Circulating endothelial progenitor cells (EPCs) are regulated by stromal cell-derived factor-1alpha (SDF-1α) and are reduced in type 2 diabetes mellitus (DM). SDF-1α is a substrate of dipeptidyl-peptidase-4 (DPP-4), so we investigated whether or not DPP-4-inhibitors modulate EPC levels in type 2 DM patients with coronary artery disease (CAD). Methods Thirty patients with CAD and type 2 DM treated using an ordinary regimen were enrolled. EPC and SDF-1α levels were compared between those receiving additional 24-week treatment with a DPP-4-inhibitor (n=11) and no additional treatment (n=19). We determined the HbA1c, 1.5-Anhydro-D-glucitol (1,5-AG), coronary flow reserve (CFR), brain natriuretic peptide (BNP), E/e', and circulating EPC proportion and SDF-1α levels at baseline and the end of follow-up. The CFR was assessed using a dual-sensor-equipped guidewire. The primary endpoints were changes in the EPC count, SDF-1α levels, and CFR from baseline to the end of follow-up. The secondary endpoints were changes in the HbA1C and 1,5-AG, which are useful clinical markers of postprandial hyperglycemia, as well as the BNP and E/e'. Results After the 6-month follow-up, compared with ordinary regimen subjects, the patients receiving a DPP-4-inhibitor showed no significant increase in the EPC proportion (−0.01%±0.50% vs. 0.02%±0.77%, p=0.87), SDF-1α level (−600.4±653.6 vs. −283.2±543.1 pg/ml, p=0.18), or CFR (0.0+0.2 vs. 0.1+0.6, p=0.20), whereas both the 1.5-AG level (2.4±4.6 vs. −0.7±2.5 μg/dL, p=0.07) and HbA1C (−0.8%±1.8% vs. 0.0%±0.7%, p=0.02) were improved. There were no significant differences between the two groups in changes in the BNP and E/e'. Conclusion DPP-4 inhibition with sitagliptin did not increase or decrease the EPC proportion, SDF-1α level, or CFR, although the glycemic control was improved.

著者

重住 道彦

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.48, no.10, pp.1564-1574, 1960

---

北大医学部吉本の考案せる超低周波テーブル,すなわち,テーブルの固有振動数0.32c/s,二方向,全重量2.9kg,非制動テーブルで,これに, Elliottの水銀加速度計(0~3000c/sまで測定可能)を取り付けたものを使用し,健康成人男女11名について,生理的状態のもとに與えうる種々女の負荷に対するバリストカージオグラムの形態ならびに発生時間の変化から,各波の素因を明らかにする実驗を試み次のごとき結果をえた.すなわち, H波は心尖の收縮初期の移動により, I波は心室内におこる血流の反作用により, J波は大動脈弓への血流衝撃によると考えられ, I-Jストロークは心拍出量ならびに拍出速度に関係し, K波は血流の下行末端衝撃により, L波は一種の休止期と解され, M波は動脈内血流に関係があり, NおよびO波は拍出血流とは関係が薄く,左右方向バリストは心筋自体の反力の影響が強いことを認めた.

著者

Hideharu Hagiya Ryohei Kokado Akiko Ueda Hideo Okuno Daiichi Morii Shigeto Hamaguchi Norihisa Yamamoto Hisao Yoshida Kazunori Tomono

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.2603-18, (Released:2019-05-22)

参考文献数

10

被引用文献数

25

---

Objective The importance of antimicrobial stewardship is increasingly highlighted in this age of antimicrobial resistance. A better comprehension of adverse drug events (ADEs) can promote the appropriate use of antibiotics. We aimed to quantify the incidence of ADEs associated with broad-spectrum systemic antibiotics in a hospital setting. Methods We conducted a six-month prospective, observational study at Osaka University Hospital to describe the incidence of ADEs in patients hospitalized in general wards undergoing treatment with broad-spectrum antibiotics (carbapenems, piperacillin/tazobactam [PIPC/TAZ], and anti-methicillin-resistant Staphylococcus aureus agents). The occurrence of ADE was defined as any cardiac, gastrointestinal, hepatobiliary, renal, neurologic, hematologic, dermatologic, or musculoskeletal manifestation after 48 hours or more of systemic antibiotic therapy. Results The 3 most frequently prescribed antibiotics were PIPC/TAZ (242 cases), meropenem (181 cases), and vancomycin (92 cases). Of 689 patients, 118 (17.1%) experienced ADEs, including gastrointestinal (6.4%), hepatobiliary (4.2%), dermatologic (2.5%), and renal (2.3%) manifestations. Patients treated with PIPC/TAZ, meropenem, doripenem, vancomycin, daptomycin, and teicoplanin developed ADEs at rates of 20.7%, 16.0%, 15.4%, 19.6%, 11.8%, and 10.9%, respectively. Conclusion Our study provides a quantitative value for the incidence of ADEs associated with broad-spectrum antibiotics in clinical practice. To optimize patient safety, clinicians need to be aware of the risks associated with antibiotic administration.

著者

Tatsuyoshi Ikeue Hiroaki Kawachi Hiroshi Yoshida Eiichiro Tanaka Susumu Noguchi Akari Fukao Satoshi Terashita Tomoko Tajiri Sadao Horikawa Takakazu Sugita

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.2109-18, (Released:2019-02-01)

参考文献数

25

被引用文献数

4

---

Lymphoproliferative disorders can occur in patients with autoimmune disorders who undergo long-term methotrexate therapy (MTX-LPD). Although the manifestations of MTX-LPD are diverse, little attention is paid to endobronchial involvement. We herein describe two patients with MTX-LPD who presented with parenchymal pulmonary tumors and endobronchial involvement of LPD; one had lymphomatoid gramulomatosis and the other LPD. The patients had no tumors adjacent to the endobronchial lesions. The endobronchial findings included multiple protruded mucosal lesions covered with white material, which was pathologically consistent with LPD. Recognition of the findings may help in making an earlier diagnosis of MTX-LPD in appropriate settings.

著者

Yoshitaka Tomoda Masato Toya Satoshi Kagawa Kazutoyo Tanaka

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.2573-18, (Released:2019-04-17)

参考文献数

1

被引用文献数

4

著者

Soichiro Suzuki Shotaro Naito Yoshiyuki Numasawa Mizuho Asada Norikazu Shoji Moko Zeniya Daiei Takahashi Hidehiko Sato Soichiro Iimori Naohiro Nomura Eisei Sohara Tomokazu Okado Yasuyoshi Ishiwata Masashi Nagata Tatemitsu Rai Takanori Yokota Shinichi Uchida

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.1785-18, (Released:2019-02-25)

参考文献数

23

被引用文献数

23

---

Encephalopathy is a rare side effect of cephalosporin treatment. We herein present a case of encephalopathy induced by ceftriaxone, a third-generation cephalosporin, in a patient with renal failure. An 86-year-old woman on maintenance hemodialysis received ceftriaxone for Helicobacter cinaedi bacteremia. Her mental status deteriorated during antibiotic treatment, and an electroencephalogram revealed triphasic waves predominantly in the frontal area. Her consciousness improved after the discontinuation of the antibiotic due to the suspicion of ceftriaxone-induced encephalopathy. This is the first reported case of encephalopathy associated with high plasma and cerebrospinal fluid ceftriaxone concentrations, and provides significant evidence for a causal relationship between the administration of ceftriaxone and the onset of encephalopathy.

著者

Akiko Tateishi Kei Nakashima Kazuei Hoshi Yu Oyama Toshiki Ebisudani Masafumi Misawa Masahiro Aoshima

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.1796-18, (Released:2019-01-10)

参考文献数

17

被引用文献数

7

---

Pulmonary tumor thrombotic microangiopathy (PTTM) is a complication characterized by dyspnea, pulmonary hypertension, and occasionally sudden death. We encountered a man who developed PTTM and had an inhalation history of chemical herbicides and abnormal findings on chest computed tomography, mimicking chemical inhalation lung injury. He was diagnosed with PTTM with adenocarcinoma by a transbronchial lung biopsy and received chemotherapy and anticoagulant therapy. He survived for one month. An autopsy revealed primary gastric cancer with PTTM that can have a presentation similar to diffuse pulmonary diseases, including chemical inhalation lung injury. The examination of a biopsy specimen is crucial in such patients.

著者

Sho Ishigaki Tatsuhiro Masaoka Hisako Kameyama Miho Kawaida Kaori Kameyama Takehiko Mori Takanori Kanai

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.57, no.22, pp.3249-3254, 2018-11-15 (Released:2018-11-15)

参考文献数

18

被引用文献数

6

---

The number of patients with methotrexate-associated lymphoproliferative disorder (MTX-LPD) is increasing. We describe a case of MTX-LPD of the stomach. After treatment with methotrexate for rheumatoid arthritis, the patient developed left cervical lymphadenopathy and an ulcerative lesion in the stomach, which was presumed to be a mucosa-associated lymphoid tissue (MALT) lymphoma. However, we suspected MTX-LPD, based on the clinical course and the positivity of in situ hybridization for the detection of the Epstein-Barr encoding region. After the cessation of MTX, the left cervical lymphadenopathy and the gastric lesion disappeared. This is first report of gastric MTX-LPD that was presumed to be MALT lymphoma.

著者

Haitian Nan Keisuke Shimozono Yuta Ichinose Mai Tsuchiya Kishin Koh Masaki Hiraide Yoshihisa Takiyama

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.1839-18, (Released:2018-10-17)

参考文献数

13

被引用文献数

2

---

SPG5 is a rare subtype of autosomal recessive hereditary spastic paraplegia caused by a homozygous mutation in the oxysterol-7a-hydroxylase gene, CYP7B1. We describe the first Japanese patient with SPG5 with a novel mutation in the CYP7B1 gene. On exome sequencing, we identified a homozygous frameshift mutation, c.741delA, p.K247fs, in exon 3 of the CYP7B1 gene. The patient showed spastic paraparesis with white matter hyperintensities in the bilateral corona radiata and periventricular and subcortical regions on brain magnetic resonance imaging. The present study expands the mutation spectrum of CYP7B1 and provides an opportunity to study the genotype-phenotype correlation in SPG5.

著者

Yuki Takigawa Keiichi Fujiwara Takashi Saito Takamasa Nakasuka Taichi Ozeki Sachi Okawa Kenji Takada Yoshitaka Iwamoto Hiroe Kayatani Daisuke Minami Ken Sato Miki Nagao Takuo Shibayama

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.1454-18, (Released:2018-10-17)

参考文献数

25

被引用文献数

10

---

A 66-year-old man was transferred to our hospital for pneumonia that was resistant to sulbactam/ampicillin and levofloxacin therapy. Chest computed tomography showed the rapidly progressive formation of multiple cavities. Methicillin-resistant Staphylococcus aureus (MRSA) was isolated, and the patient was diagnosed with necrotizing pneumonia caused by community-acquired MRSA (CA-MRSA). The MRSA strain had type IV staphylococcus cassette chromosome mec and genes encoding Panton-Valentine leucocidin (PVL). CA-MRSA necrotizing pneumonia with the PVL gene is rare; only three cases have been previously reported in Japan. We administered anti-MRSA antibiotics and the patient achieved complete clinical and radiological improvement.