著者

Akira Inoue Takuhiro Yamaguchi Keiko Tanaka Akihiro Sakashita Keisuke Aoe Nobuhiko Seki Koichi Hagiwara

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.0872-18, (Released:2019-02-01)

参考文献数

18

被引用文献数

7

---

Introduction The early integration of palliative care into standard cancer treatment has become a global standard. The Palliative care Emphasis program on symptom management and Assessment for Continuous medical Education (PEACE) has been conducted in Japan, and previous studies have reported that the PEACE workshop was able to improve various palliative care skills of participants. However, whether or not the effects of the program are long-lasting and if the program consequently changed physicians' practice with regard to lung cancer patients have been unclear. Methods Web-based surveys, including the palliative care knowledge test (PEACE-Q), the Palliative Care self-reported Practice Scale (PCPS), and the Palliative Care Difficulties Scale (PCDS), were conducted among lung cancer physicians in Japan. The differences in the survey results between participants and non-participants of the PEACE workshop were examined. Results Among 923 respondents (455 respiratory physicians, 345 pulmonary surgeons, and 123 others), 519 had participated in the PEACE workshop. The total PEACE-Q score was significantly higher in the PEACE workshop participants than in non-participants (28.0 versus 24.5, p<0.0001). The score was significantly higher in respiratory physicians than in pulmonary surgeons (27.4 versus 25.5). The total PCPS and PCDS scores were also significantly better in workshop participants than in non-participants (71.8 versus 67.1 and 34.3 versus 36.9, respectively), although some domains of PCDS were similar between the groups. Conclusion The PEACE program improved the knowledge and practices with regard to palliative care and resolved difficulties associated therewith among lung cancer physicians. In regions where palliative care specialists are insufficient, such educational programs may be effective. Mini Abstract The PEACE program improved the knowledge and practices with regard to palliative care and resolved difficulties associated therewith among lung cancer physicians in Japan.

著者

グレイル アルフレッド

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.19, no.7, pp.886-893, 1931

著者

Mieko Sugiura Koichi Shibata Satoshi Saito Yoshiko Nishimura Hiroshi Sakura

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.1619-18, (Released:2019-02-01)

参考文献数

24

被引用文献数

5

---

A 64-year-old woman with no previous mental illness took a single 500 mg tablet of levofloxacin for cystitis. Two hours later, she developed psychosis with involuntary movement and severe hyperventilation with respiratory alkalosis. Cranial magnetic resonance imaging findings were unremarkable, and an electroencephalogram revealed no epileptiform discharge. Her symptoms improved on the third day after levofloxacin was discontinued. Levofloxacin-associated encephalopathy with psychotic features is a rare adverse event. Disturbance of GABAergic interneurons by levofloxacin may lead to hyperventilation via dysfunction of the brainstem respiratory network. Physicians should be aware of hyperventilation as an additional serious symptom of levofloxacin-associated encephalopathy in acute settings.

著者

Satoshi Kumakura Takashi Nakamichi Nonoka Suzuki Shu Yamakage Ayako Ishikawa Emi Fujikura Satoko Sato Takeshi Aoki Hiroaki Musha Katsuko Kikuchi Tasuku Nagasawa Hiroshi Sato Sadayoshi Ito Mariko Miyazaki

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.2378-18, (Released:2019-02-01)

参考文献数

22

被引用文献数

4

---

A 66-year-old man was admitted to our hospital because of multiple refractory skin ulcers. Based on his severe systemic arterial calcification and severe calcium-phosphate imbalance due to severe kidney dysfunction, we initially considered calciphylaxis. However, a skin biopsy provided a diagnosis of cholesterol crystal embolization. Although we initiated hemodialysis, steroid treatment, and low-density lipoprotein-cholesterol apheresis, he died of multiple intestinal perforation. An autopsy showed cholesterol crystals occluding multiple organ arterioles. This case suggests that skin ulcers in patients with chronic kidney disease may be an important diagnostic hallmark and may be associated with several serious diseases.

著者

Mayu Minamoto-Higashioka Ryoichi Kawamura Hironobu Umakoshi Maki Yokomoto-Umakoshi Daisuke Utsunomiya Haruhiko Osawa Shiori Kondo

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.1360-18, (Released:2019-01-10)

参考文献数

29

被引用文献数

2

---

Objective Glucose-lowering drug-induced hypoglycemia is a serious complication and there have been a few reports of seasonal variations in hypoglycemia in patients with type 2 diabetes. The aim of the present study was to examine the association between severe drug-induced hypoglycemia and seasonal variations, and to elucidate the contributing factors. Methods This retrospective, single center clinical study, analyzed the cases of 125 patients who required emergency hospitalization for severe drug-induced hypoglycemia between January 1, 2001 and December 31, 2014. The period from November to April was defined as the cold season. Results Severe hypoglycemia occurred more often in the cold season than in the warm season. In the cold season, 62 of 9,981 (0.6%) emergency department visits involved patients who required hospitalization for drug-induced hypoglycemia. In contrast, in the warm season, 27 of 8,649 (0.3%) visits involved patients who required hospitalization for drug-induced hypoglycemia (p=0.002). The proportion of patients treated with sulfonylurea (SU) in the cold season was higher than that in the warm season. Even the use of low-dose SU caused hypoglycemia in the cold season. In the SU-treated group, the proportion of patients with white blood cell and/or C-reactive protein elevation was higher in the cold season than in the warm season (p=0.04). Conclusion Severe glucose-lowering drug-induced hypoglycemia occured more frequently in the cold season than in the warm season, and was associated with an inflammatory state in patients treated with SU.

著者

Takayuki Toyama Tomotaka Kawayama Takashi Kinoshita Yohei Imamura Makoto Yoshida Koichiro Takahashi Kazuhiko Fujii Ikkou Higashimoto Tomoaki Hoshino

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.0488-17, (Released:2018-09-12)

参考文献数

37

被引用文献数

9

---

Objective This multicenter, cross-sectional, non-interventional trial aimed to investigate adherence barriers to inhaled medicines when compared with oral medicines in Japanese patients with chronic obstructive pulmonary disease (COPD) and asthma. Methods The self-reporting "Adherence Starts with Knowledge 20" (ASK-20) questionnaire was administered for adherence barriers of inhaled and oral medicines to outpatients with regular clinic attendance. Results Patients with COPD and asthma reported different adherence barriers to inhaled medicines. Independent adherence barriers (odds ratio [95% confidence interval]) to inhaled medicines relative to those for oral medicines among patients with COPD and asthma were those related to item Q8 ( "I know if I am reaching my health goals"; 2.49 [1.39-4.47]; p=0.0022) and item Q2 ( "I run out of my medicine because I do not get refills on time"; 2.69 [1.26-5.75]; p=0.0127), respectively. Among patients with poor adherence to only inhaled medicines, those with COPD and asthma recognized item Q3 ( "consuming alcohol and taking medicines"; 6.63 [1.27-34.7]; p<0.05) and item Q1 ( "forget to take medicines only sometimes"; 4.29 [1.83-10.0]; p<0.05), respectively, were recognized as independent adherence barriers to inhaled medicines. The total ASK-20 scores and total barrier counts in patients with poor adherence to inhaled medicines were significantly higher than in those without poor adherence among patients with asthma (p=0.0057) but not those with COPD (p>0.05). Conclusion These results will aid in personalizing education on adherence to inhaled medicines among patients with COPD and asthma.

著者

Shohei Kawachi Keisaku Fujimoto

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.58, no.1, pp.39-46, 2019-01-01 (Released:2019-01-01)

参考文献数

21

被引用文献数

2

---

Objective This study was performed to determine the usefulness of a newly developed spirometer for the quantitative assessment of dynamic lung hyperinflation (DLH) following incremental hyperventilation in chronic obstructive pulmonary disease (COPD). Methods The subjects were 54 patients with COPD and 25 healthy volunteers. Each subject was asked to hyperventilate for 30 seconds with stepwise increments starting at the resting respiration rate and increasing to respiratory rates of 20, 30, and finally 40 breaths/min while using a newly developed spirometer. The relationship between the observed inspiratory capacity (IC) reduction following incremental hyperventilation as an index of DLH and spirometry or the 6-minute walking distance was examined. Results The IC did not decrease significantly from the resting IC, even when the respiratory rate was increased, in the healthy volunteer group. However, in the COPD patient group, the IC decreased with increases in the respiratory rate. Significant correlations were found between all IC parameters and the severity of COPD. A significant negative correlation was also found between the decreased IC and the 6-minute walking distance. Conclusion These findings suggest that the quantitative assessment of DLH following incremental hyperventilation using the newly developed spirometer may be useful for the assessment of pathophysiological impairment in patients with COPD.

著者

Minoru Matsubara Shoji Hirasaki Seiyuu Suzuki

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.46, no.13, pp.971-974, 2007 (Released:2007-07-02)

参考文献数

12

被引用文献数

17 22

---

A 31-year-old woman who had ingested a toothpick consulted our hospital because of epigastralgia. An abdominal computed tomography (CT) demonstrated a toothpick penetrating the gastric wall. Endoscopic examination demonstrated an ingested toothpick protruding from the prepyloric antrum. The whole toothpick was removed using a basket catheter without complications. CT images were useful to acquire clinical information such as location of the toothpick end. Unintentional ingestion of toothpicks must be considered potentially dangerous. The locations of both ends of the toothpick should be confirmed by CT or ultrasonography;and then, the toothpick should be removed as soon as possible.

著者

ブラウン ルードウヒッヒ

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.4, pp.75-81, 1916

著者

森田 昂 岡田 隆道 大賀 辰次郎 加納 正 岡田 弘

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.68, no.4, pp.397-403, 1979

被引用文献数

1

---

系統的アミロイド症を伴つた骨髄腫に2種の癌を併発した希な症例を経験した.またこの例は6年前の喉頭癌の手術時にすでに単クローン性γ血症をみとめ,その後次第にM成分量の増量と共に骨髄腫の病像を完成した点でも興味がもたれた.症例: 70才,男性. 64才時に喉頭の扁平上皮癌で摘除をうけ,癌周囲組織に形質細胞浸潤が目立つた.血清総蛋白7.8g/dl中fast γ域に1.8g%のM成分を認めたが放置. 5年後心不全症状で緊急入院.血清総蛋白10.4g/dl中IgG-λ型のM成分が3.7g%を占めたが,この時期では尿BJ蛋白は陰性.骨髄中の形質細胞は未熟型のものも含めて4.8%で,骨髄腫の診断を確定しえなかつた.その後右足にBowen病を発症し,その切除標本の癌周囲組織には形質細胞浸潤はなかつた.入院7カ月後に至つてBJが出現,すなわちBJ escapeがみられ,さらに血清蛋白M成分の漸増と正常γ-glの著減,骨髄中異型形質細胞の著増をみとめて骨髄腫と診断した. prednisolone, cyclophosphamideの併用治療を開始し著効を見たが,心不全が増強し死亡した.剖検により全身諸臓器の骨髄腫細胞浸潤と,心,肝,脾,腎,副腎などにアミロイド沈着が認められた.本例の検討を通じて単クローン性γグロブリン血症と癌の関係,骨髄腫・アミロイド症・癌の複雑な合併にみられる免疫学的背景,骨髄腫の自然史などについて考察した.なお, Bowen病は種々の悪性腫瘍を合併するが骨髄腫を合併した報告例はない.本例が最初である.

著者

小林 哲郎

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.91, no.4, pp.1152-1154, 2002-04-10 (Released:2008-06-12)

参考文献数

12

著者

Ryusuke Yoshimi

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.1657-18, (Released:2018-08-24)

参考文献数

9

被引用文献数

8

著者

Hiroaki Okada Manabu Wada Hiroyasu Sato Yoshitaka Yamaguchi Haruko Tanji Katsuro Kurokawa Toru Kawanami Toshiyuki Takahashi Takeo Kato

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.52, no.23, pp.2665-2668, 2013 (Released:2013-12-01)

参考文献数

16

被引用文献数

6 19

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We report the case of a 48-year-old woman presenting with an elevated serum creatine kinase level (hyperCKemia) associated with an initial attack of neuromyelitis optica (NMO). The patient initially showed general fatigue with fever. Laboratory findings showed hyperCKemia and subsequently she developed a slight weakness of both lower limbs and reduced vision. Autoantibodies against aquaporin 4 were found in her serum, and a retrospective examination of viral titers indicated a possible coxsackie virus group A10 infection. The present case suggests that hyperCKemia-mediated disease onset is involved in some patients with NMO, and furthermore, it may be related to muscular destruction associated with viral infection.

著者

Takako SAEKI Kensuke SUZUKI Hajime YAMAZAKI Syoji MlYAMURA Hiroshi KOIKE Hideo MORISHITA Fumitake GEJYO

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.42, no.10, pp.1011-1015, 2003 (Released:2006-03-27)

参考文献数

32

被引用文献数

6 10

---

Although pheochromocytoma in a patient with endstage renal disease (ESRD) is considered extremely rare, we recently encountered 4 ESRD patients with pheochromocytoma. Three were symptomatic, and in the fourth patient the tumor was discovered as an adrenal incidentaloma. Plasma catecholamine levels were significantly increased in two patients. In each case, 131I-MIBG scintigraphy showed accumulation of the radionuclide in the adrenal tumor, which was identified by MRI or CT scanning, and adrenalectomy was conducted without serious complications. Although paroxysmal hypertension is a common symptom in patients with ESRD, pheochromocytoma must be eliminated by careful evaluation.(Internal Medicine 42: 1011-1015, 2003)

著者

Fraisse Thibaut Crouzet Julien Lachaud Laurence Durand Anne Charachon Sylvie Lavigne Jean Philippe Sotto Albert

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.1935-1940, 2011

被引用文献数

12 5

---

<b>Objective</b> Candiduria is a common finding in the growing population of very old patients that has not been previously studied. The objective was to study candiduria in the population aged 85 and over, including an estimation of the incidence, factor of acquisition, and evaluation of treatment and mortality.<br> <b>Methods</b> retrospective monocentric study.<br> <b>Materials</b> medical charts of patients aged of 85 and over who have candiduria diagnosed at Nimes University Hospital.<br> <b>Results</b> The prevalence of candiduria in the hospitalized very old patients was 8.9%. More than half of strains isolated were <i>C. albicans</i> (59%). Mean age was 89.7 years old with 53 women and 20 men. Urinary catheter (55%) and prior antibiotic use (67%) were commonly found. Fifteen patients with candiduria were treated, consistently with fluconazole. Patients treated had higher Mini Mental Test score than the others. A high C-reactive protein level, Mac Cabe score or Charlson's score >7 were associated with 6 months mortality.<br> <b>Conclusion</b> Episodes of candiduria in oldest old were associated with frailty and vulnerability of the patient. The medical decision for antifungal treatment is usually difficult to make but it did not seem to influence mortality.<br>

著者

Mikio Shiba Yasuo Sugano Yoshihiko Ikeda Hatsue Ishibashi-Ueda Takahiro Ohara Takuya Hasegawa Hideaki Kanzaki Toshihisa Anzai

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.55, no.7, pp.751-754, 2016 (Released:2016-04-01)

参考文献数

11

被引用文献数

2 5

---

A 74-year-old man, who had a history of a mitral valve replacement for rheumatic heart disease (RHD) 30 years previously, was admitted with progressive heart failure. Massive calcification was observed around the left atrium on multidetector CT, in addition to a late gadolinium enhancement (LGE)-positive layer adjacently outside of the calcification on MRI. He underwent a second mitral valve replacement for the prosthetic valve failure. Pathohistological analyses of a tissue section of the left atrial wall from a surgical specimen revealed lymphocyte and macrophage infiltration that coincided with the LGE-positive layer on MRI, suggesting the existence of sustained active inflammation even after the long period of RHD.

著者

Satoshi Konno Yoshihiro Matsuno Shingo Ichimiya Masaharu Nishimura Yoshikazu Kawakami

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.1241-18, (Released:2018-10-17)

参考文献数

12

被引用文献数

3

---

In 1982, we reported a case of retroperitoneal fibrosis (RPF) exhibiting various clinical manifestations. Our current understanding of immunoglobulin G4 (IgG4)-related disease led us to consider it as a possible diagnosis because all of the patient's clinical features could be explained by this disease entity. To confirm our hypothesis, we re investigated the histopathological findings of resected specimens that had been stored for 35 years postoperatively. Typical pathological findings together with predominant IgG4+ plasma cell infiltration confirmed a potential diagnosis of IgG4-related RPF. Furthermore, we observed positive immunohistochemical staining for several molecules associated with T regulatory and T follicular helper cells.

著者

Tomoki Kokubun Masayoshi Oikawa Yasuhiro Ichijo Yoshiyuki Matsumoto Tetsuro Yokokawa Kazuhiko Nakazato Yoshiyuki Sato Shinya Takase Hiroharu Shinjo Hitoshi Yokoyama Hitoshi Suzuki Shu-ichi Saitoh Yasuchika Takeishi

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.57, no.11, pp.1597-1600, 2018-06-01 (Released:2018-06-01)

参考文献数

16

被引用文献数

3

---

A 40-year-old man was transferred to our hospital following an isolated horse kick injury to the anterior chest wall. The case showed bi-fascicular block, severe tricuspid valve regurgitation due to ruptured chordae tendineae of the anterior leaflet, moderate mitral valve regurgitation due to prolapse of mitral anterior leaflet, and hypokinetic motion of the inferior septal wall. Both tricuspid and mitral insufficiency were completely repaired by a surgical operation. Fortunately, these injuries were not fatal in this case, but the comprehensive assessment of cardiac damage and careful observation are important for managing patients with cardiac injury.

著者

Saori Yamamoto Tasuku Nagasawa Koichiro Sugimura Atuhiro Kanno Shunsuke Tatebe Tatsuo Aoki Haruka Sato Katsuya Kozu Ryo Konno Kotaro Nochioka Kimio Sato Hiroaki Shimokawa

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.0959-18, (Released:2018-10-17)

参考文献数

16

被引用文献数

8

---

Anderson-Fabry disease (AFD) is a rare X-linked disorder caused by deficient activity of the lysosomal enzyme α-galactosidase A (α-GAL A). We herein report 10 cases of AFD in 5 families (3 men and 7 women) that were found to have a specific common mutation in R301Q (G-to-A transition in exon 6 [codon 301] resulting in the replacement of a glutamine with an arginine residue). We evaluated their clinical characteristics, residual enzymatic activity, and plasma concentrations of globotriaosylsphingosine (Lyso-Gb3). Although all 10 cases had cardiac and renal manifestations in common, their clinical manifestations were markedly divergent despite the same genetic abnormality.

著者

Takeshi Kawashita Mikio Nakajima Richard H. Kaszynski Masamitsu Shirokawa Tomotsugu Nakano Koji Ochiai Yoshitaka Inoue Hideaki Goto

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.1041-18, (Released:2018-09-12)

参考文献数

12

被引用文献数

1

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A 28-year-old man with type 1 diabetes mellitus was admitted for shock and coma due to diabetic ketoacidosis. Despite aggressive treatment and management of the patient's underlying clinical issues, the patient remained in a comatose state. Further investigations revealed an excess consumption of psychotropic agents; however, there was no evidence of an insulin overdose. Physicians should be aware that, in patients who are highly dependent upon insulin, an overdose of psychotropic agents can lead to hypoxic-ischemic brain injury.