著者

Naohiro Oda Tomoaki Hirahara Yusuke Fujioka Reo Mitani Ichiro Takata

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.2825-19, (Released:2019-06-27)

参考文献数

20

被引用文献数

6

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We herein report the case of a 62-year-old man diagnosed with Legionella pneumonia while engaged in recovery work in a flooded area after the Heavy Rain Event of July 2018 in Japan. The patient was intubated and maintained on mechanical ventilation and continuous hemodiafiltration. He was also administered antimicrobial therapy with ciprofloxacin and azithromycin. After 53 days in the hospital, he was discharged. It is important to recognize the risk of Legionella infection and to take measures to prevent it during recovery work that involves exposure to water and soil after a flood disaster.

著者

Shunsuke Mori Tamami Yoshitama Yukitaka Ueki

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.663-670, 2018-03-01 (Released:2018-03-01)

参考文献数

38

被引用文献数

28

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Objective This study was designed to directly compare the outcomes of tofacitinib therapy for methotrexate-refractory rheumatoid arthritis (RA) between biologic-naïve patients and patients who had experienced an inadequate response to biological agents. Methods We prospectively enrolled and followed 113 patients who had a high or moderate clinical disease activity index (CDAI) (36 biologic-naïve patients and 77 biologic-experienced patients). Patients received 5 mg of tofacitinib twice daily. Effectiveness and adverse events were examined at month 6 of treatment. Results At month 6, 65 patients (57.5%) reached CDAI50, which is defined as achieving ≥50% improvement. The number of previous biological agents was twice as high in CDAI50 non-responders as in responders (2.2 versus 1.1, p<0.001), but there was no significant difference in the type of previous agents or the reason for discontinuation. According to a multivariate logistic regression analysis, the previous use of biological agents [odds ratio (OR) 4.48, p=0.002] and the concurrent use of prednisolone (OR 2.40, p=0.047) were associated with a failure to achieve a CDAI 50 response. Biologic-naïve patients were more likely to achieve CDAI50 than biologic-experienced patients (80.6% versus 46.8%, p=0.001). Mean CDAI values were higher in biologic-experienced patients (11.4 versus 4.8, p=0.001), and remission rates were higher in biologic-naïve patients (41.7% versus 11.7%, p=0.001). Biologic-naïve patients more rapidly achieved remission. Rates of discontinuation resulting from adverse events were similar in both groups. Conclusion Although tofacitinib can provide an effective treatment option for intractable RA patients, its impact on outcomes is lower in patients with previous biologic failure.

著者

Yasuki Habu

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.2535-18, (Released:2019-06-07)

参考文献数

29

被引用文献数

15

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Objective Gastroesophageal reflux disease (GERD) is a highly prevalent disorder that negatively affects patients' quality of life and reduces their work productivity. The medical expenses associated with the treatment of GERD are the highest among all digestive diseases. Current guidelines recommend the administration of a standard dose of proton pump inhibitor (PPI) for eight weeks as an initial GERD treatment. However, there is growing concern regarding the safety of PPI treatment. Recently, a novel potassium-competitive acid blocker (P-CAB), vonoprazan (VPZ), was approved for the treatment of reflux esophagitis in Japan and may provide clinical benefits in GERD treatment. This study was conducted to evaluate the cost-effectiveness of a P-CAB, VPZ vs. a PPI, lansoprazole (LPZ), for the acute medical treatment of reflux esophagitis. Methods A clinical decision analysis was performed using a Markov chain approach to compare VPZ to LPZ in the acute treatment of reflux esophagitis in Japan. Results The P-CAB strategy was superior to the PPI strategy in terms of cost-effectiveness (direct cost per patient to achieve clinical success) and the number of days for which medication was required. Sensitivity analyses revealed that this superiority was robust within the plausible range of probabilities. This remained true even when the healing rates in cases of mild esophagitis were applied. Conclusion The P-CAB strategy was consistently superior to the conventional PPI strategy using the original LPZ in terms of cost-effectiveness and the number of days for which medication was required. Thus, VPZ appears to be the drug of choice for the acute medical treatment of reflux esophagitis.

著者

Taku Yasui Wataru Shioyama Makiko Oboshi Toru Oka Masashi Fujita

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.2415-18, (Released:2019-02-25)

参考文献数

17

被引用文献数

14

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Objective Oral anticoagulants (OACs), which include direct oral anticoagulants (DOACs) and warfarin, are widely used for the prevention of thromboembolic events in patients with atrial fibrillation (AF). Cancer is associated with a prothrombotic state as well as an increased bleeding risk. Few data are available on the efficacy and safety of OACs in Japanese cancer patients with AF. We sought to investigate the efficacy and safety of OACs in this population. Methods This retrospective cohort study included active cancer patients in whom AF was recorded by electrocardiography in our hospital from January 2014 to December 2016 and who were treated with DOACs or warfarin. Patients were followed for 1 year. The study outcomes were stroke or systemic embolism and major bleeding. Result A total of 224 patients with AF and active cancer were treated with OACs (DOACs, n=127; warfarin, n=97). Overall, stroke or systemic embolism and major bleeding occurred in seven (3.8%/year) and eight (4.9%/year) patients, respectively. Stroke or systemic embolism occurred in three patients in the DOAC group (2.8%/year) and four patients in the warfarin group (5.4%/year). Major bleeding occurred in four patients in the DOAC group (4.0%/year) and four patients in the warfarin group (6.5%/year). Conclusion The rates of stroke or systemic embolism and major bleeding events were not negligible among Japanese cancer patients with AF receiving OACs. Further investigations on the optimal management of Japanese patients with AF and cancer are needed.

著者

Joe Senda Kunihiko Araki Yasushi Tachi Hazuki Watanabe Yuichi Kagawashira Mizuki Ito Naoki Atsuta Masahisa Katsuno Hirohisa Watanabe Gen Sobue

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.58, no.3, pp.433-436, 2019-02-01 (Released:2019-02-01)

参考文献数

25

被引用文献数

2 5

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An otherwise healthy 44-year-old woman exhibited isolated unilateral oculomotor nerve palsy accompanied by an influenza A infection. An intra-orbital MRI scan revealed that her right third intracranial nerve was enlarged and enhanced. She recovered completely during the first month after treatment with oseltamivir phosphate. Although intracranial nerve disorders that result from influenza infections are most frequently reported in children, it is noteworthy that influenza can also cause focal intracranial nerve inflammation with ophthalmoparesis in adults. These disorders can be diagnosed using intra-orbital MRI scans with appropriate sequences and through immunological assays to detect the presence of antiganglioside antibodies.

著者

Taku Nakase Taro Yamashita Yoshimasa Matsuo Toshiya Nomura Keiko Sasada Teruaki Masuda Yohei Misumi Kotaro Takamatsu Seitaro Oda Yutaro Furukawa Konen Obayashi Hirotaka Matsui Yukio Ando Mitsuharu Ueda

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.2456-18, (Released:2019-06-07)

参考文献数

17

被引用文献数

3

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We report the clinical features of a patient with hereditary ATTR amyloidosis associated with a novel mutation (Y114S, p.Y134S). A 65-year-old Japanese man was admitted to our hospital after a 3-year history of progressive dyspnea on exertion. Five years previously, he presented dysesthesia in both hands caused by carpal tunnel syndrome. A genetic analysis revealed a base pair substitution of adenine to cytosine in the second codon of exon 4, residue 114, in the TTR gene (c.401A>C). The clinical characteristics were progressive cardiomyopathy with a poor vital prognosis, late onset, sporadic case, bilateral carpal tunnel syndrome, hypothyroidism, and small fiber neuropathy.

著者

Tetsushi Murakami Tadashi Yoshida Arata Kurokochi Kimiharu Takamatsu Yu Teranishi Keisuke Shigeta Satoshi Tamaki Shinya Morita Ryuichi Mizuno Mototsugu Oya

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.1945-18, (Released:2019-06-07)

参考文献数

22

被引用文献数

3

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Accidental hypothermia is defined as a core body temperature <35°C. Even with the use of multiple active rewarming methods, it has a high mortality rate. No standard treatment strategy for moderate or severe hypothermia in the absence of cardiac arrest has yet been established. We herein report three patients with severe or moderate accidental hypothermia who were treated by hemodialysis in the acute phase. This case report with a literature review describes the usefulness of hemodialysis for the treatment of moderate and severe accidental hypothermia without cardiac arrest.

著者

Masahiro Nagano Takashi Ayaki Natsuko Koita Toshiyuki Kitano Momoko Nishikori Naoki Goda Sachiko Minamiguchi Akio Ikeda Akifumi Takaori-Kondo Ryosuke Takahashi

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.58, no.6, pp.849-854, 2019-03-15 (Released:2019-03-15)

参考文献数

20

被引用文献数

4 8

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Primary central nervous system lymphoma (PCNSL) and chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) can share clinical features and may be indistinguishable, even after brain biopsy. We encountered a case of Epstein-Barr virus-positive (EBV+) PCNSL recurrence in a patient with clinical features of CLIPPERS, and repeat brain biopsy was required to reach the correct diagnosis. Four years after the initial diagnosis and treatment of PCNSL, "peppering" punctate enhanced lesions with transient steroid responsiveness were detected during brain magnetic resonance imaging (MRI). A second brain biopsy supported a diagnosis of CLIPPERS, while a third biopsy confirmed the diagnosis of recurrent PCNSL.

著者

Junko Ishii Yukiko Shishido-Hara Michi Kawamoto Satoru Fujiwara Yukihiro Imai Kazuo Nakamichi Nobuo Kohara

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.0696-17, (Released:2018-04-27)

参考文献数

22

被引用文献数

11

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A 37-year-old woman with systemic lupus erythematosus (SLE) presented with gait disturbance and cognitive dysfunction. Brain magnetic resonance imaging (MRI) revealed small, punctate, T2-/fluid-attenuated inversion recovery-hyperintense and T1-hypointense lesions without gadolinium enhancement, which is atypical for progressive multifocal leukoencephalopathy (PML). On a pathological examination of biopsied brain tissues, JC virus-infected cells were hardly detected via immunohistochemistry but were certainly detected via in situ hybridization, conclusively verifying the PML diagnosis. After tapering off the immunosuppressant and mefloquine administration, the MRI findings revealed gradual improvement, and she has been stable for over 18 months. A punctate MRI pattern is not specific to natalizumab-associated PML but may be a ubiquitous early sign useful for the early diagnosis of PML.

著者

Hisashi Takahashi Tadashi Kimura Natsuko Yuki Akira Yoshioka

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.8941-17, (Released:2017-11-01)

参考文献数

16

被引用文献数

4

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A 79-year-old woman with a history of Guillain-Barré syndrome (GBS) developed somnolence and tetraparesis after pneumonia. Based on clinical and laboratory findings, she was diagnosed with complications of acute inflammatory demyelinating polyneuropathy (AIDP) and acute disseminated encephalomyelitis (ADEM). Anti-galactocerebroside (Gal-C) IgG antibodies were detected in her serum. Cases of recurrent GBS in patients who are positive for this antibody are extremely rare. The anti-Gal-C IgG antibodies likely played an important role in the pathogenesis of the AIDP and ADEM.

著者

Noboru Oda Tomoko S. Kato Akihisa Hanatani Kazuo Niwaya Takeshi Nakatani Hatsue Ishibashi-Ueda Soichiro Kitamura Kazuhiko Hashimura Masafumi Kitakaze Kazuo Komamura

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.49, no.11, pp.1013-1016, 2010 (Released:2010-06-01)

参考文献数

15

被引用文献数

7 10

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Reversible posterior leukoencephalopathy syndrome (RPLS) is one of the important adverse events following organ transplantation, associated with calcineurin inhibitors (CNIs). We describe a case of 54-year-old woman, who was diagnosed with RPLS within weeks after transplantation. Considering the risk of causing fatal rejection by discontinuation of CNIs, the immunosuppressive regimen of the patient was switched from a cyclosporine A-based regimen to a tacrolimus-based regimen. The patient recovered rapidly from RPLS following the switch to tacrolimus. This case demonstrated that not only discontinuation but also a substitution of CNIs would be a valid treatment option for RPLS in transplant recipients.

著者

Hajime Kato Yoshimi Takahashi Chifumi Iseki Ryosuke Igari Hidenori Sato Hiroyasu Sato Shingo Koyama Muneshige Tobita Toru Kawanami Mitsuyoshi Iino Kenichi Ishizawa Takeo Kato

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.58, no.10, pp.1411-1416, 2019-05-15 (Released:2019-05-15)

参考文献数

37

被引用文献数

32

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Objective Dementia is a major cause of disruption for a healthy life expectancy in Japan. It has been suggested that the number of teeth is a modifiable risk factor for cognitive impairment and dementia. We therefore examined the possible association between the cognitive function and the number of natural and artificial teeth in community-dwelling Japanese elderly individuals. Methods Among the participants in our prospective, community-based study, 210 elderly individuals (103 men and 107 women; 78.1±4.9 years; mean age±standard deviation) underwent both dental examinations and a Mini-Mental State Examination (MMSE), as well as various medical checkups, in 2016 and 2017. Results The number of natural teeth was significantly associated with an individual's MMSE score. The percentage of cognitively normal subjects (MMSE scores: 27-30) decreased significantly with a decrease in the number of natural teeth. Among the MMSE items, the calculation ability was significantly and independently associated with the number of natural teeth. Regression was calculated as the predicted score of MMSE =21+0.3× (years of schooling) +0.1× (number of natural teeth). Among individuals with 19 or fewer natural teeth, those who had a total of 20 teeth or more, including both natural and artificial teeth, had significantly higher MMSE scores than those who had 19 or fewer natural and artificial teeth combined. Conclusion The number of natural teeth was significantly associated with the cognitive function, especially the calculation ability, and the use of artificial teeth was associated with the preservation of the cognitive function in community-dwelling elderly individuals.

著者

Takashi Yoshida Takuto Tachita Haruna Fujinami Yoshiko Oshima Hirokazu Sasaki Yoshiaki Marumo Tomoko Narita Asahi Ito Masaki Ri Shigeru Kusumoto Takashi Ishida Hirokazu Komatsu Shinsuke Iida

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.2082-18, (Released:2019-04-17)

参考文献数

27

被引用文献数

8

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Infectious diseases, including those caused by fungi, remain important issues in patients receiving malignant lymphoma chemotherapy. We herein report a rare case of Exophiala dermatitidis fungemia during chemotherapy in a 67-year-old woman admitted to our hospital. She had a fever that could not be resolved despite antifungal therapy. Yeast-like fungi were detected in blood culture samples, but biochemical identification was difficult. E. dermatitidis, a black mold, was identified using time-of-flight mass spectrometry. The patient finally improved after her treatment was switched to voriconazole. Fungal infection is difficult to diagnose and treat, but this novel approach can improve patients' outcomes.

著者

Koichi Takeda Tsuneaki Kenzaka Shigehiro Kuroki Eiji Kajii

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.51, no.12, pp.1649, 2012 (Released:2012-06-15)

参考文献数

1

被引用文献数

1

著者

四ノ宮 成祥

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.101, no.11, pp.3103-3113, 2012-11-10

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バイオテロは決して頻度の高い事象ではないが,一旦起きると社会への衝撃は計り知れない.我々は,過去にオウム真理教のバイオテロ未遂事件やアメリカ炭疽菌郵送事件のような事例を経験したことを忘れずに,適切な対策を講ずる必要がある.また,過去に生物兵器として開発された生物剤がテロに用いられることのないよう注視するだけでなく,今後は遺伝子組換え技術を利用した新たなタイプの生物剤を用いたテロが起きないよう防止することも大切である.<br>

著者

Mitsue Rikimaru Yutaka Ohsawa Alexander M. Wolf Kiyomi Nishimaki Harumi Ichimiya Naomi Kamimura Shin-ichiro Nishimatsu Shigeo Ohta Yoshihide Sunada

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.51, no.24, pp.3351-3357, 2012 (Released:2012-12-15)

参考文献数

14

被引用文献数

10 51

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Objective Post-transcriptional taurine modification at the first anticodon ("wobble") nucleotide is deficient in A3243G-mutant mitochondrial (mt) tRNALeu(UUR) of patients with myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS). Wobble nucleotide modifications in tRNAs have recently been identified to be important in the accurate and efficient deciphering of codons. We herein examined whether taurine can alleviate mitochondrial dysfunction in patient-derived pathogenic cells and prevent clinical symptoms in MELAS patients. Methods and Results The addition of taurine to the culture media ameliorated the reduced oxygen consumption, decreased the mitochondrial membrane potential, and increased the oxidative stress in MELAS patient-derived cells. Moreover, high dose oral administration of taurine (0.25 g/kg/day) completely prevented stroke-like episodes in two MELAS patients for more than nine years. Conclusion Taurine supplementation may be a novel potential treatment option for preventing the stroke-like episodes associated with MELAS.

著者

Kokoro Ozaki Takuya Ohkubo Tetsuo Yamada Kotaro Yoshioka Masahiko Ichijo Takamasa Majima Shunsuke Kudo Takumi Akashi Keiji Honda Eisaku Ito Mayumi Watanabe Masaki Sekine Miwako Hamagaki Yoshinobu Eishi Nobuo Sanjo Satoru Ishibashi Hidehiro Mizusawa Takanori Yokota

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.3451-3458, 2018-12-01 (Released:2018-12-01)

参考文献数

29

被引用文献数

1 8

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Progressive encephalomyelitis with rigidity and myoclonus (PERM) is an autoimmune disorder involving the brainstem and spinal cord and is sometimes associated with thymoma. We encountered a 75-year-old woman with typical PERM features, glycine receptor antibody, and thymoma. Her neurologic symptoms improved after thymectomy, but she unexpectedly developed anasarca with massive pleural effusions and hypoalbuminemia and finally succumbed to death. The autopsy showed edema and mononuclear infiltration in the pleura but no neuropathological findings typical of PERM. Effective treatment of PERM can reverse the neuropathological signs of encephalomyelitis. The autoimmune nature of anasarca is possible but not proven.

著者

Keiko Ohnari Kazumasa Okada Osamu Higuchi Hidenori Matsuo Hiroaki Adachi

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.57, no.20, pp.3021-3024, 2018-10-15 (Released:2018-10-15)

参考文献数

17

被引用文献数

1 6

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An 82-year-old woman developed neck weakness and dysarthria with antibodies against acetylcholine receptor (AChR) and low-density lipoprotein receptor-related protein 4 (LRP4). Myasthenia gravis (MG) was diagnosed by edrophonium and repetitive nerve stimulation tests. Her symptoms resolved completely by immunotherapy. One year later, she presented with muscle weakness and bulbar palsy accompanied by atrophy and fasciculation. Her tendon reflexes were brisk, and Babinski's sign was positive. She was diagnosed with probable amyotrophic lateral sclerosis (ALS). Immunotherapy did not improve her symptoms, and she ultimately died of respiratory failure. MG and ALS may share a pathophysiology, including anti-LRP4 antibodies at the neuromuscular junction.

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.100, no.4, pp.893-893, 2011

著者

Genki Usui Yohei Takayama Hirotsugu Hashimoto Takehiro Katano Masahiro Yanagiya Masashi Kusakabe Tamaki Miura Jun Matsumoto Hajime Horiuchi Seiji Okubo

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.1962-18, (Released:2018-12-18)

参考文献数

19

被引用文献数

17

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Postoperative cerebral embolism after left upper lobectomy caused by a thrombus in the pulmonary vein stump (PVS) is a serious complication. However, it is unclear if cerebral embolism can develop after other types of lobectomy. We present a case of a 68-year-old man with cerebral embolism after left lower lobectomy with a longer PVS than normal. There were no clinically suspected sources for the thrombus except for the PVS. This thrombus seemed to have formed in the PVS. The endovascularly removed thrombus contained scattered nuclear debris around neutrophils, suggesting a physiological response caused by tissue injury.