著者

Kiyozumi Suzuki Hiromasa Otsuka

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.56, no.17, pp.2381-2382, 2017-09-01 (Released:2017-09-01)

参考文献数

2

被引用文献数

3

著者

Honami MORI Yutaka KURODA Shigeki IMAMURA Akira TOYODA Izumi YOSHIDA Masanobu KAWAKAMI Kaoru TABEI

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.42, no.8, pp.665-669, 2003 (Released:2006-03-27)

参考文献数

20

被引用文献数

37 56

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Objective High-dose trimethoprim-sulfamethoxazole (TMP-SMX) is known to cause hyperkalemia by blocking amiloride-sensitive sodium (Na) channels in distal nephrons. The purpose of this study was to establish whether the standard dose of TMP-SMX could cause electrolyte disorders. Methods and Patients Serum Na, potassium (K) and creatinine (Cr) levels were examined retrospectively in 53 of 77 patients prescribed TMP-SMX, before and after taking the antibiotic combination. Results Electrolyte disorders (Na <135 mEq/l and/or K>5.0 mEq/l) were found in 14 of the 53 patients (26.4%) during TMP-SMX treatment. The average dose was 145.7±24.9 mg/day. The dose of TMP was significantly larger in patients with electrolyte disorders (267.7±84.2 mg vs. 101.9±9.38 mg, p=0.0024). Electrolyte disorders were also seen in 9.1% and 22.2% of patients given the low dose (TMP <80 mg) or standard dose (TMP 80-120 mg) of TMP-SMX, respectively. Electrolyte disorders were seen in 85.7% of patients with renal dysfunction (Cr >1.2 mg/dl), compared with 17.5% of patients with normal renal function (p=0.0008). Logistic regression analysis showed that the dose of TMP and the presence of renal dysfunction increased the incidence of electrolyte disorders with an odds ratio of 2.35 and 80.29, respectively. Conclusion Electrolyte disorders, particularly hyperkalemia and hyponatremia can be detected in patients given TMP-SMX. These disorders are more frequent in patients given high doses, but can also be detected after low-dose administration. Renal dysfunction accelerates the incidence of electrolyte disorders induced by TMP-SMX.(Internal Medicine 42: 665-669, 2003)

著者

Ryoichi Miyazaki Keita Watanabe Masakazu Kaneko Sho Nagamine Nobuhiro Hara Tomofumi Nakamura Yasutoshi Nagata Toshihiro Nozato Takashi Ashikaga

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.5502-20, (Released:2020-12-07)

参考文献数

11

被引用文献数

2

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An 80-year-old woman with acute posterolateralmyocardial infarction, cardiogenic shock, and acute heart failure was admitted to our hospital. Transthoracic echocardiography (TTE) showed dysfunction of the left ventricular inferolateral wall motion and severe mitral valve regurgitation (MR). Emergency coronary angiography revealed triple-vessel stenosis. We performed transesophageal echocardiography in the catheter room to diagnose the cause of MR. Severe tenting of the mitral valve and no rupture of the papillary muscles were revealed. We considered ischemic MR likely to improve with revascularization and performed percutaneous coronary intervention. Subsequently, the patient's circulatory dynamics rapidly stabilized, and MR was significantly improved on follow-up TTE.

著者

Yuji Yamamoto Yuko Ohara Ami Iwai Reina Hara Takanori Matsuki Kiyoharu Fukushima Yohei Oshitani Hiroyuki Kagawa Kazuyuki Tsujino Kenji Yoshimura Mari Miki Keisuke Miki Masahide Mori Hiroshi Kida

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.3991-19, (Released:2020-03-19)

参考文献数

15

被引用文献数

1 5

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Influenza vaccination can trigger various adverse reactions, and thrombocytopenia is also rarely reported. Although patients with mild thrombocytopenia are sometimes asymptomatic, severe thrombocytopenia can cause severe bleeding. We herein report a rare case of severe thrombocytopenia that occurred within one day of influenza vaccination and diffuse alveolar hemorrhage (DAH) leading to acute respiratory failure. The patient was treated with glucocorticoid pulse therapy, intravenous immunoglobulin, and temporary mechanical ventilation, and eventually he made a full recovery. Vaccine-related thrombocytopenia and DAH should be considered adverse reactions, even if they develop very soon after vaccination.

著者

Kenichiro Tokunaga Noboru Hagino

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.1399-1403, 2017-06-01 (Released:2017-06-01)

参考文献数

15

被引用文献数

16 37

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We performed a retrospective chart review of three patients with hypomyopathic dermatomyositis and rapidly progressive interstitial lung disease. The patients were Japanese women of 71, 69, and 65 years of age. Two patients were anti-melanoma differentiation-associated gene 5 (anti-MDA5) antibody-positive and 1 was anti-aminoacyl-tRNA synthetase (anti-ARS) antibody-positive. Their respiratory statuses deteriorated despite the administration of glucocorticoid, calcineurin inhibitors, and intravenous cyclophosphamide therapy. We subsequently administered rituximab. The anti-ARS antibody-positive patient survived, while 2 anti-MDA5 antibody-positive patients died.

著者

Shinichi Mizuno

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.5939-20, (Released:2020-10-14)

被引用文献数

2

著者

Miwa Morikawa Masahiro Shinoda Shinichiro Ohta Yuto Yoshida Takatomo Hirouchi Kanako Shinada Osamu Sasaki Takashi Sato Kenichi Kamachi Masaharu Shinkai

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.5528-20, (Released:2020-11-02)

参考文献数

23

被引用文献数

5

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Objective We aimed to clarify clinical and laboratory characteristics of coronavirus disease 2019 (COVID-19) patients, and further explore the features to detect COVID-19 pneumonia at the first visit to community-based hospitals. Methods Diagnoses of COVID-19 were based on positive results from real-time reverse-transcription polymerase chain reaction testing of nasopharyngeal-swab specimens. We retrospectively reviewed the medical records of patients showing positive results. The clinical characteristics and results of blood tests were compared between the patients with and without pneumonia. The risk factors associated with pneumonia were then evaluated by a multivariable analysis. Results The study cohort comprised 154 patients, including 117 patients (76.0%) with pneumonia at first visit. Significant differences were seen in age, the frequency of fever, tachycardia, desaturation (peripheral oxygen saturation ≤95%), any comorbidity, neutrocyte count and fraction, lymphocyte count and fraction, platelet count, lactate dehydrogenase (LDH), C-reactive protein (CRP), and fibrinogen between the patients with and without pneumonia. Using a multivariable analysis, CRP ≥0.3 mg/dL and fibrinogen >400 mg/dL were found to be associated with the presence of pneumonia. Conclusion Community-based settings for screening COVID-19 patients should perform chest X-ray and blood tests for white blood cell fractions, fibrinogen, LDH, and CRP. Of these, elevations in the CRP and fibrinogen levels could be critically associated with the presence of COVID-19 pneumonia.

著者

Akinari Noda Kikuko Morita Masaki Saito Teppei Shimasaki Daisuke Kurai Keitaro Nakamoto Haruyuki Ishii Takeshi Saraya

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.5565-20, (Released:2020-11-02)

参考文献数

8

被引用文献数

9

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A 60-year-old woman was admitted to our hospital due to COVID-19 pneumonia with a chief complaint of persistent low-grade fever and dry cough for two weeks. Thoracic computed tomography demonstrated a crazy paving pattern in the bilateral lower lobes. In a COVID-19 ward, we used a novel wireless stethoscope with a telemedicine system and successfully recorded and shared the lung sounds in real-time between the red and green zones. The fine crackles at the posterior right lower lung fields changed from mid-to-late (day 1) to late inspiratory crackles (day 3), which disappeared at day 5 along with an improvement in both the clinical symptoms and thoracic CT findings.

著者

Takayuki Hoshiyama Tatsuhiko Wada Shin Nihonyanagi Ryo Kameda Minako Yamaoka-Tojo Michinari Fukuda Jyunya Ako Kunihiro Yamaoka Yoko Takayama

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.5601-20, (Released:2020-11-02)

参考文献数

42

被引用文献数

6

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Objective To describe the clinical features and clinical course of individuals diagnosed with asymptomatic SARS-CoV-2 infection or mild COVID-19. Patients The study participants consisted of 7 crewmembers of the passenger cruise-liner, Diamond Princess, who were admitted to our hospital after becoming infected with SARS-CoV-2 aboard the ship. Methods The data on patient background and biochemical test results were obtained from the patients' medical records. All patients had a chest X-ray, and a throat swab and sputum samples were sent for culture on admission. Results The median age of the 7 patients, of whom 4 were male and 3 were female, was 39 years (range: 23-47 years). On admission, none of them had fever, but 4 (57%) had a cough. None of them showed any signs of organ damage on laboratory testing. Chest X-ray showed pneumonia in one individual, which resolved spontaneously, while the other 6 had normal chest X-ray findings. Culture of throat swabs and sputum samples revealed that 4 patients (57%) had bacterial upper respiratory infections (Haemophilus influenzae, Klebsiella pneumoniae, and Staphylococcus aureus). The period from a positive PCR test to negative conversion ranged from 5 to 13 days, with a median of 8 days. Conclusion Healthy young adults without risk factors who acquire SARS-CoV-2 infection may have an asymptomatic infection or may experience mild COVID-19. In addition to obesity, an older age, underlying illness, and being overweight can lead to a risk of exacerbation; thus, hospital management for such individuals may be desirable. Culturing respiratory samples may be useful for diagnosing secondary bacterial pneumonia.

著者

Satoshi Ide Shinichiro Morioka Makoto Inada Norio Ohmagari

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.6112-20, (Released:2020-11-02)

参考文献数

2

被引用文献数

15

著者

Masanobu Ueno Kazuhisa Nakano Ippei Miyagawa Yoshiya Tanaka

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.4127-19, (Released:2020-04-30)

参考文献数

15

被引用文献数

7

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We herein report five patients with nasal mucosa and sinus involvement who were diagnosed with immunoglobulin G4-related disease (IgG4-RD). In all cases, the lacrimal, parotid, and submandibular glands were swollen; biopsies of these glands were risky, so the labium and nasal mucosa were instead targeted. All patients tested positive through these biopsies, suggesting alternative sites for confirming IgG4-RD. These five patients had first been diagnosed and unsuccessfully treated for allergic rhinitis or chronic sinusitis. After the IgG4-RD diagnosis, they were administered corticosteroid therapy, which drastically improved the nasal mucosa and sinus involvement. When refractory allergic rhinitis or sinusitis is detected, IgG4-RD should be considered.

著者

Yuki Yoshimatsu Noriyuki Ebi Ryunosuke Ooi Takuto Sueyasu Saori Nishizawa Miyuki Munechika Kohei Yoshimine Yuki Ko Hiromi Ide Kosuke Tsuruno Kazunori Tobino

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.5463-20, (Released:2020-11-02)

参考文献数

18

被引用文献数

5

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The efficacy of epidermal growth factor tyrosine kinase inhibitors (EGFR-TKIs) in lung squamous cell carcinoma is said to be low. Thus far, only four cases of osimertinib in lung squamous cell carcinoma have been published. We experienced a case of EGFR mutant lung squamous cell carcinoma in which fifth-line treatment with osimertinib was effective after T790M EGFR mutation turned positive. Osimertinib was resumed after sixth-line chemotherapy was ineffective, showing efficacy again. Osimertinib may be a promising treatment option for EGFR mutant lung squamous cell carcinoma. This is the first report to show its effect in a case of rechallenge after intervening chemotherapy. It may therefore be important to evaluate EGFR in never-smoker lung squamous cell carcinoma patients.

著者

Takahiro Shinzato Ken Ohara Hiroaki Kaminaga Taro Sugase Takahiro Masuda Daisuke Nagata Katano Saki Yoshitaka Kinoshita Taro Kubo Toshihiro Shimizu Koji Nanmoku Takashi Yagisawa

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.59, no.21, pp.2733-2736, 2020-11-01 (Released:2020-11-01)

参考文献数

15

被引用文献数

1

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A transdermal patch formulation of a non-steroidal anti-inflammatory drug (NSAID) used by a 44-year-old man resulted in acute interstitial nephritis and acute tubular injury. This patient also had a history of mild kidney dysfunction and osteoporosis. The NSAID patch had been prescribed after a traffic accident. He was also receiving a vitamin D analog and taking over-the-counter calcium supplements. Two months later, renal dysfunction and hypercalcemia were discovered. A renal biopsy showed acute interstitial nephritis and acute tubular injury. Once these agents were withdrawn, the renal function recovered. This is the first reported occurrence of biopsy-proven acute interstitial nephritis attributable to NSAID patch usage.

著者

Yoshie Ojima Kinya Sawada Hiroshi Fujii Tsuyoshi Shirai Ayako Saito Saeko Kagaya Satoshi Aoki Yoichi Takeuchi Tomonori Ishii Tasuku Nagasawa

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.57, no.9, pp.1301-1308, 2018-05-01 (Released:2018-05-01)

参考文献数

47

被引用文献数

7

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A previously healthy 58-year-old man was admitted for muscle pain and weakness [manual muscle testing (MMT) of 4/4 for upper and lower limbs]. We detected elevated levels of inflammatory makers and PR3-anti-neutrophil cytoplasmic antibody (ANCA). Subsequently, the muscle weakness rapidly progressed to an MMT of 2 for all limbs. Magnetic resonance imaging indicated muscle edema, and the creatine kinase (CK) level increased to 29,998 U/L. Methylprednisolone (mPSL) and cyclophosphamide pulse therapy improved the patient symptoms. MMT recovered to 4 for all limbs. A muscle biopsy showed degenerated muscle fibers surrounded by neutrophil-predominant infiltration. In addition, lamina elastic breakdown and fibrinoid necrosis of arterioles were observed. A final diagnosis of microscopic polyangiitis (MPA) limited to the muscles was made.

著者

Yusuke Kobari Tasuku Nagasawa

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.3365-3367, 2017-12-15 (Released:2017-12-15)

参考文献数

4

被引用文献数

2 7

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A previously healthy 77-year-old Japanese man presented with a 2-week history of daily fevers peaking at 38°C, chills, hearing loss, and almost 10 kg of unintentional weight loss over 2 months. Pure tone audiometry showed mixed conductive-sensorineural hearing loss: right, 63.6 dB, left, 80.0 dB. Blood tests after admission showed a high myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) level (>300 U/mL), so we suspected ANCA-related vasculitis. The Japanese Otorhinolaryngology Society has recently been advocating the concept of otitis media with ANCA-associated vasculitis (OMAAV). Our case met the criteria proposed, leading to our diagnosis.

著者

Chikako Monoe Hiroyasu Shimizu Kanae Kitaguchi Hiraku Funakoshi

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.59, no.20, pp.2619-2622, 2020-10-15 (Released:2020-10-15)

参考文献数

9

被引用文献数

3

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Amiodarone, prescribed for cardiac conditions, including dysrhythmia, is associated with bradycardia. However, few reports have demonstrated that bradycardia is observed when amiodarone is used in combination with sofosbuvir, a direct-acting antiviral drug for chronic hepatitis C. We herein report the case of a male patient in his 70s with chronic atrial fibrillation and prostatic hyperplasia and was also taking amiodarone, who experienced severe bradycardia and syncope a day after taking sofosbuvir and ribavirin for chronic hepatitis C. After discontinuing amiodarone, ribavirin, and sofosbuvir, bradycardia did not recur. Therefore, we must consider drug interactions between amiodarone and sofosbuvir in patients with severe bradycardia.

著者

Takafumi Yamaya Tomohisa Baba Eri Hagiwara Satoshi Ikeda Takashi Niwa Takaaki Kitayama Kota Murohashi Katsuyuki Higa Yozo Sato Takashi Ogura

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.5731-20, (Released:2020-10-07)

参考文献数

16

被引用文献数

17

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Coronavirus disease 2019 (COVID-19) has been recognized as a worldwide pandemic. However, the clinical course of COVID-19 remains poorly characterized. Although some cases of pneumothorax have been reported, they all had pulmonary complications or were managed with mechanical ventilation. We herein report a case of pneumothorax that developed even though the patient had no pulmonary underlying diseases and had never been managed with mechanical ventilation. In the present case, a lung bulla was found on chest computed tomography during treatment for COVID-19. We concluded that COVID-19 affected the formation of the lung bulla and induced the complication of pneumothorax.

著者

Eri Oguro Shiro Ohshima Akie Kikuchi-Taura Atsuko Murata Kentaro Kuzuya Yasutaka Okita Hidetoshi Matsuoka Satoru Teshigawara Maiko Yoshimura Yuji Yoshida Kentaro Isoda Eriko Kudo-Tanaka Yoshinori Harada Toshio Kaminou Yukihiko Saeki

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.58, no.9, pp.1355-1360, 2019-05-01 (Released:2019-05-01)

参考文献数

17

被引用文献数

3 8

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A 26-year-old woman with Takayasu's arteritis (TAK) experienced back and neck pain during tocilizumab (TCZ) treatment. The levels of C-reactive protein were normal, and ultrasonography revealed no significant changes. Diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) showed signal enhancement in the walls of several arteries. Contrast computed tomography showed arterial inflammation in the same lesion. After increasing the dose of prednisolone and TCZ, all signal enhancements decreased and continued to decrease, as observed on days 76 and 132. Thus, DWIBS may be a novel imaging modality for assessing the disease activity of TAK, particularly during follow-up.

著者

Ryusei Nishigori Yoko Warabi Yukiko Shishido-Hara Kazuo Nakamichi Yasuhiro Nakata Takashi Komori Eiji Isozaki

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.3038-19, (Released:2019-07-31)

参考文献数

15

被引用文献数

5 9

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The patient was a 74-year-old woman with rheumatoid arthritis who developed ataxia. MRI revealed T2-hyperintense lesions predominantly in the left middle cerebellar peduncle. Punctate or linear Gd enhancement was also observed on T1-weighted images. A brain biopsy was conducted and the pathology revealed a mild demyelinated lesion. PCR of biopsied brain tissues revealed the presence of JCV DNA, but JCV-infected oligodendroglia-like cells were not apparent on immunohistochemistry. Sensitive in-situ hybridization, however, detected three JCV-positive cells and the infiltration of CD4+ and CD8+ T cells and plasma cells was also observed. Immunosuppressants were tapered off and mirtazapine and mefloquine administered, resulting in a favorable outcome.

著者

Chiho Ishida Kazuya Takahashi Yuko Kato-Motozaki Atsuro Tagami Kiyonobu Komai

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.4836-20, (Released:2020-09-19)

参考文献数

15

被引用文献数

7

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Objective To determine the clinicopathological features of levodopa or dopamine agonist (DA) responders with multiple system atrophy (MSA), an autopsy-confirmed diagnosis is vital due to concomitant cases of MSA and Parkinson's disease (PD). We therefore aimed to investigate the effectiveness of levodopa and DA in autopsy cases of MSA without PD and thereby clarify the clinical course, magnetic resonance imaging (MRI) findings, and pathological features of levodopa-responsive MSA cases. Patients and Methods The medical records (clinical data, MRI findings, and pathological findings) of 12 patients with MSA were obtained, and the patients were pathologically confirmed to not have PD. The clinical diagnoses of the patients were MSA with predominant parkinsonism (MSA-P) (n=7), MSA with predominant cerebellar ataxia (MSA-C) (n=4), and progressive supranuclear palsy (PSP) with a concomitant pathology of MSA (n=1). Results Nine patients received a maximum dose of 300-900 mg of levodopa as treatment, which was effective in two MSA-P patients and mildly effective in another two MSA-P patients. DA was mildly effective in one MSA-C patient. The levodopa responders showed marked autonomic dysfunction relatively late and became bedridden after 10 years. Additionally, they exhibited bilateral hyperintense putaminal rims in MRIs after six and nine years, respectively, after disease onset. One levodopa responder and one DA mild responder showed relatively mild neurodegeneration of the putamen. Conclusion Levodopa responders, despite having MSA-P, may show a relatively slow progression in putaminal neurodegeneration, and might maintain prolonged daily life activities in cases without an early occurrence of autonomic dysfunction.