著者

眞島 惠吉

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.44, no.11, pp.1102-1108, 1956

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The cerebral circulation and metabolism were determined by the modification of Kety & Schmidt's nitrous oxide method in 30 case with hemiplegia by the cerebral vascular accidents and one case of apoplectic stroke. In the hemiplegic patients as the results of significantly increased cerebral vascular resistance (CVR) apparently decreased cerebral blood flow (CBF), cerebral oxygen delivery (CDo₂) and reduced cerebral oxygen consumption (CMRo₂) were observed.<br>By the increased cerebral oxygen extraction ratio (CERo₂) the diminution of CMRo₂ was lesser than the reduction of CDo₂. There was no significantly change in cerebral respiratory quotient (CRQ).<br>In the case of apoplectic stroke a diminution of CMRo₂ and CERo₂ were observed. In the essential hypertension a increase of CVR was a only change, but when the cerebral arteriosclerosis accompanied with it, CBF and CMRo₂ were slightly decreased.<br>In the cerebral arteriosklerosis one case showed no much change, but the another one proved the decreas of CBF and CMRo₂ according to the increased CVR.<br>In the patients of hemiplegia we observed the relationship between cerebral hemodynamics and the existence of mental changes, the duration after the stroke, the findings of retinae, age and the rehabilitation. However there was no relationship between them.<br>We assumed that in these cases the changes of cerebral hemodynamics were more based on the advanced cerebral arteriosclerosis or in addition hypertension than the local damage of the brain.<br>We calculated the cerebral vascular reactivity following the changes of CVR after 5% carbon dioxide inhalation.<br>Though in the patients of hemiplegia with hypertension were observed some reactivity, it was very much diminished. We measured the effects of papaverin hydrochloride, priscol, aminophyllin and stellateganglion block on the cerebral circulation and then we concluded the methods which let the abnormality of cerebral circulation and metabolism return to normal, is effecient as the therapeutic means.

著者

Masahiro Oomura Yuto Uchida Keita Sakurai Takanari Toyoda Kenji Okita Noriyuki Matsukawa

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.0604-17, (Released:2018-04-27)

参考文献数

19

被引用文献数

6

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We herein report a patient with Miller Fisher syndrome mimicking Tolosa-Hunt syndrome. A 47-year-old man presented with right orbital pain and diplopia. On a neurological examination, he had right oculomotor nerve palsy and diminished deep tendon reflexes. Brain magnetic resonance imaging failed to show any parenchymal lesions; however, the bilateral oculomotor nerves were gadolinium-enhanced. The presence of a triad of orbital pain, ipsilateral oculomotor nerve palsy, and a rapid response to steroid therapy met the diagnostic criteria for Tolosa-Hunt syndrome. After discharge, antibodies against GQ1b and GT1a were reported to be positive only with phosphatidic acid. The present case was ultimately diagnosed as an incomplete phenotype of Miller Fisher syndrome.

著者

Hirokazu Tokuyasu Takehito Fukushima Hirofumi Nakazaki Eiji Shimizu

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.51, no.9, pp.1133-1138, 2012 (Released:2012-04-29)

参考文献数

22

被引用文献数

3 17

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An 86-year-old woman who underwent placement of a prosthetic aortic valve for regurgitation 5 years previously was admitted because of spiking fever. The blood culture results were positive for gram-negative rods, which were identified as Achromobacter xylosoxidans. Approximately 4 months after being sent to the hospital, transthoracic echocardiography revealed vegetation at the prosthetic aortic valve. Ultimately, a diagnosis of A. xylosoxidans endocarditis of the prosthetic aortic valve was made. We report an extremely rare case of bacteremia associated by prosthetic valve endocarditis with A. xylosoxidans. In addition, we review 10 previously reported cases of endocarditis caused by A. xylosoxidans.

著者

野村 恭一

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.96, no.9, pp.2046-2053, 2007-09-10

参考文献数

20

被引用文献数

1 1

著者

吉村 道由 荒田 仁 出口 尚寿 髙嶋 博

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.103, no.8, pp.1876-1884, 2014

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しびれは個々でその定義が異なり,鑑別も非常に多い.高齢者においては,年齢に伴う動脈硬化性変化や骨性変化によりきたす疾患も多くみられる.診断をするにあたっては既往症や基礎疾患などの背景と伴に,発症様式,性状,部位なども重要となる.しびれのメカニズムを述べるとともに,末梢性,中枢性,部位別に分類してそれぞれの代表的な疾患の特徴や,診断をすすめるうえでの検査について述べる.

著者

Norihiko Shinozaki

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.1527-1530, 2012 (Released:2012-06-15)

参考文献数

12

被引用文献数

2 2

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A 78-year-old man had right foot ulceration. The skin perfusion pressure (SPP) at the dorsum was 12 mmHg. Angiography revealed right iliac artery occlusion and diffuse stenosis of right superficial femoral artery. After stenting of the iliac arteries, the SPP was still 23 mmHg. Hence, we also inserted stents in the right superficial femoral artery. The anterior tibial artery remained stenosed, and the posterior tibial and fibular arteries were occluded. However, as the SPP had increased to 46 mmHg the treatment was discontinued. The ulcers improved. Measurement of SPP during a procedure may be useful in determining the treatment endpoint.

著者

長谷川 浩司 星 智 遠山 裕樹 伊藤 信市 伊藤 知子 若林 博人

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.90, no.7, pp.1333-1335, 2001-07-10

参考文献数

9

被引用文献数

2 1

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症例は82歳,男性. 1日10行以上の水様下痢にて入院,腹部超音波およびCTにて膵頭部に径4cmの腫瘤を認めた.血清VIP (Vasoactive Interstitial Polypeptide)濃度970pg/mlと高値を示し, WDHA (Watery diarrhea, Hypokalemia, Achlorhydria)症候群と診断. octoreotide acetate (以下o. a.と略す)投与にて症状改善後,膵頭十二指腸切除術を施行し現在経過良好である.本例は過去の報告例中世界最高齢の貴重な症例と考え報告した.

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.News4-News4, 2011

著者

Ryohei Ono Koji Uehara Izumi Kitagawa

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.0219-17, (Released:2018-03-09)

参考文献数

32

被引用文献数

19

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Emphysematous osteomyelitis is a rare but potentially fatal infection. It is caused by gas-forming organismsand is characterized by the presence of intraosseous gas. A 75-year-old woman with untreated diabetes mellitus presented with difficulty in moving and anorexia. Laboratory studies revealed inflammation, a urinary infection, and diabetic ketoacidosis. Klebsiella pneumoniae was detected in both urine and blood cultures. Computed tomography and magnetic resonance imaging revealed emphysematous lesions in the paravertebral soft tissue, spinal canal, and iliopsoas muscle, with intraosseous gas at L1 and L2. These findings led to a diagnosis of emphysematous osteomyelitis. We herein review 35 reported cases of emphysematous osteomyelitis including our case.

著者

Hiroyasu Kaya Jun Ozaki Hirokazu Okumura

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.0269-17, (Released:2018-03-09)

参考文献数

22

被引用文献数

4

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Objective This study retrospectively evaluated fungal dissemination due to hospital reconstruction and explored effective methods of predicting an outbreak. Methods Patients suspected of having invasive aspergillosis were tested for Aspergillus galactomannan antigen before and after reconstruction, and the mean values of three months of testing for positive patients were determined. The characteristics of patients with aspergillosis during this period were also assessed. Results Forty-five patients were positive for Aspergillus antigen (>0.5 cut-off index) from January 2013 to December 2014. Mean Aspergillus antigen values significantly increased following reconstruction (p<0.05). Three patients developed pneumonia due to Aspergillus and were diagnosed with "probable" invasive aspergillosis according to the EORTC/MSG criteria. We also discovered that the anteroom to contain dust was not prefabricated and a negative pressure system to remove dust was not used. After construction of the unit, no new cases of aspergillosis were diagnosed. Conclusion Many Aspergillus spores may be transiently floating during hospital reconstruction. Therefore, monthly surveillance with frequent serum galactomannan antigen testing to predict outbreaks is necessary. Surveillance of all patients in the hematology ward is especially important. Reconsideration of prophylactic antifungals may also be necessary during hospital reconstruction.

著者

Tsugumi Takayama Takuya Ozawa Akiko Sanada Tohru Watanabe Masahiro Ito Satoru Hirono Yoshifusa Aizawa Tohru Minamino

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.57, no.6, pp.823-827, 2018-03-15 (Released:2018-03-15)

参考文献数

14

被引用文献数

2

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A 33-year-old man with severe aortic regurgitation underwent initial aortic valve replacement (AVR). During the 2 years after AVR, 3 reoperations for prosthetic valve detachment were required. During hospitalization, he had no typical clinical findings, with the exception of a persistent inflammatory reaction; a pseudo-aneurysm around the Bentall graft developed 27 days after the 4th operation. This unique clinical course suggested the possibility of Behçet's disease. In the 8 years of follow-up after the administration of prednisolone, the pseudo-aneurysm did not become enlarged and the detachment of the prosthetic valve was not observed. We herein present a case of cardiovascular Behçet's disease, with a review of the literature.

著者

Ryosuke Imai Takakazu Higuchi Masaya Morimoto Ryosuke Koyamada Sadamu Okada

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.57, no.6, pp.899-901, 2018-03-15 (Released:2018-03-15)

参考文献数

11

被引用文献数

18

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A 52-year-old man who had been taking omeprazole, a proton pump inhibitor (PPI), for 25 years developed iron deficiency anemia. An evaluation of the entire gastrointestinal tract did not reveal any possible causes of gastrointestinal blood loss. The cause of the iron deficiency was considered to be a reduction in gastrointestinal iron absorption in association with the reduced secretion of gastric acid due to PPI use. This case demonstrates that long-term PPI use for as long as 25 years may cause iron deficiency anemia and should be considered in the differential diagnosis of iron deficiency anemia in long-term PPI users.

著者

Tatsuya Ueno Ryoya Kimura Tomoya Kon Rie Haga Haruo Nishijima Jin-ichi Nunomura Masahiko Tomiyama

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.0313-17, (Released:2018-02-28)

参考文献数

21

被引用文献数

3

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Miller Fisher syndrome (MFS) can be difficult to diagnose, particularly in mild cases where some of the standard triad of symptoms (external ophthalmoplegia, ataxia, and loss of deep tendon reflex) are absent. We herein report a case of the incomplete form of MFS diagnosed in a 54-year-old Japanese man who presented only with ataxia symptoms and was positive for the anti-GQ1b antibody. However, the patient also suffered from dysgeusia, a significant impairment of taste perception. We propose that dysgeusia in acute-onset ataxia cases may constitute an important clinical feature to aid in the diagnosis of the incomplete form of MFS.

著者

Ryuko Furutate Takeo Ishii Takashi Motegi Kumiko Hattori Yuji Kusunoki Akihiko Gemma Kozui Kida

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.55, no.3, pp.223-229, 2016 (Released:2016-02-01)

参考文献数

45

被引用文献数

13 46

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Objective Although chronic obstructive pulmonary disease (COPD) is characterized by systemic inflammation, the association between the neutrophil to lymphocyte ratio (NLR; an indicator of inflammation) and the clinical status of COPD has not been well studied. We hypothesized that the NLR is associated with disease severity and exacerbation in COPD patients. Methods We performed blood testing, pulmonary function testing, chest computed tomography, a body composition analysis, and a 6-minute walk test and applied the modified Medical Research Council (MMRC) dyspnea scale for 141 stable COPD patients. In addition, we calculated the body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index to evaluate the disease severity. Finally, we examined the association between the NLR and clinical parameters in stable COPD patients, and we further investigated changes in the NLR between exacerbation and the stable state. Results The NLR was positively correlated with the BODE index, extent of emphysema, and MMRC score (p<0.001 for all), while inversely correlated with airflow obstruction (p<0.001), body mass index (p<0.001), fat-free mass index (p=0.001), and the 6-minute walk distance (p<0.001). We obtained the NLR during exacerbation from 49 patients. The NLR was significantly higher at exacerbation compared to the stable state (p<0.001). Conclusion The NLR was associated with disease severity and exacerbation in COPD patients. Therefore, the usefulness of the NLR in COPD patients should be elucidated in clinical settings in future investigations.

著者

Takashi Wada Tsutomu Fukumoto Kyoko Ito Yasutaka Hasegawa Takanobu Osaki Hideyuki Ban

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.48, no.9, pp.647-655, 2009 (Released:2009-05-01)

参考文献数

20

被引用文献数

7 8

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Objective Metabolic syndrome is associated with a high risk of cardiovascular morbidity and mortality. The predominant cause of metabolic syndrome is an unhealthy lifestyle. Healthy habits are represented by Breslow's 7 healthy practices, Morimoto's 8 items and Ikeda's 6 healthy habits. This study was done to determine which set of healthy habits was most likely to result in a reduced risk of developing the metabolic syndrome. Methods From April 1, 2000 through March 31, 2007, 6,765 males and 2,789 females underwent a medical check-up at Jikei University Hospital in Japan. They completed a simple, self-administered lifestyle questionnaire based on the 3 classifications of healthy habits. The responses were divided into 3 groups (poor, moderate and favorable) according to each of the healthy habit criteria. The incidence of metabolic syndrome was defined in participants who were newly diagnosed during the follow-up using Japanese-specific diagnostic criteria. The Kaplan-Meier cumulative 7-year incidence was calculated. Kaplan-Meier curves were compared using the long-rank test adjusted for age. Results In females, Breslow's, Morimoto's and Ikeda's healthy habits showed significant differences in the incidence between poor and moderate groups, and between poor and favorable groups. In males, a significant difference was observed among the poor, moderate and favorable groups for Ikeda's healthy habits. However, no significant difference was observed for Breslow's healthy practices. Morimoto's items only showed a significant difference between the poor and moderate groups. Conclusion Among the 3 models tested, Ikeda's healthy habits were the most useful for decreasing the risk of metabolic syndrome in Japanese.

著者

Wada Takashi Fukumoto Tsutomu Ito Kyoko Hasegawa Yasutaka Osaki Takanobu Ban Hideyuki

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.48, no.9, pp.647-655, 2009

被引用文献数

1 8

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<b>Objective</b> Metabolic syndrome is associated with a high risk of cardiovascular morbidity and mortality. The predominant cause of metabolic syndrome is an unhealthy lifestyle. Healthy habits are represented by Breslow's 7 healthy practices, Morimoto's 8 items and Ikeda's 6 healthy habits. This study was done to determine which set of healthy habits was most likely to result in a reduced risk of developing the metabolic syndrome.<br> <b>Methods</b> From April 1, 2000 through March 31, 2007, 6,765 males and 2,789 females underwent a medical check-up at Jikei University Hospital in Japan. They completed a simple, self-administered lifestyle questionnaire based on the 3 classifications of healthy habits. The responses were divided into 3 groups (poor, moderate and favorable) according to each of the healthy habit criteria. The incidence of metabolic syndrome was defined in participants who were newly diagnosed during the follow-up using Japanese-specific diagnostic criteria. The Kaplan-Meier cumulative 7-year incidence was calculated. Kaplan-Meier curves were compared using the long-rank test adjusted for age.<br> <b>Results</b> In females, Breslow's, Morimoto's and Ikeda's healthy habits showed significant differences in the incidence between poor and moderate groups, and between poor and favorable groups. In males, a significant difference was observed among the poor, moderate and favorable groups for Ikeda's healthy habits. However, no significant difference was observed for Breslow's healthy practices. Morimoto's items only showed a significant difference between the poor and moderate groups.<br> <b>Conclusion</b> Among the 3 models tested, Ikeda's healthy habits were the most useful for decreasing the risk of metabolic syndrome in Japanese.<br>

著者

Tetsuo Yamaguchi Masahiro Terashima Chisato Takamura Hironobu Sakurai Kiyotoshi Ooishi Tomoya Yoshizaki Junji Yamaguchi Sadahiro Hijikata Takamasa Iwai Yuichiro Sagawa Keita Watanabe Ryoichi Miyazaki Ryo Masuda Naoyuki Miwa Masahiro Sekigawa Nobuhiro Hara Yasutoshi Nagata Takamichi Miyamoto Toru Obayashi Toshihiro Nozato

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.9605-17, (Released:2017-12-21)

参考文献数

11

被引用文献数

3

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A 55-year-old man presented with dyspnea, edema, and appetite loss. He had undergone coronary artery bypass grafting 8 years previously. He had jugular venous distention and Kussmaul's sign. Contrast-enhanced cardiac magnetic resonance imaging (CMRI) demonstrated an intrapericardial mass compressing the right ventricular (RV) cavity. T1- and T2-weighted black-blood images showed a mass with heterogeneous high signal intensity and a thick and dark rim. The mass was considered to be a chronic hematoma. After pericardiotomy with surgical removal of the hematoma, CMRI showed the marked improvement of the RV function. Late intrapericardial hematoma is rare and CMRI is useful for making a differential diagnosis.

著者

服部 信孝

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.96, no.8, pp.1614-1620, 2007-08-10

参考文献数

6

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パーキンソン病の生命予後は,levodopaの導入により劇的に改善している.一方で,levodopaの長期使用による運動合併症状も明らかにされ,特にwearing offやlevodopa-induced dyskinesiaの出現が問題になりドパミン作動薬が登場し,その運動合併症状を如何に抑えるかが治療上の中心となってきた.一方で,ELLDOPA Studyが報告され,levodopa自体における神経毒性は否定された.更にMAO(monoamine oxidase)阻害剤が登場し,進行阻止剤の可能性が近年頓に注目されてきている.しかしながら,完全無比なる治療薬は存在せず,臨床医はその副作用についても十分熟知する必要がある.治療薬のメリットデメリットを秤に掛けて治療することが最も重要と考える.<br>

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

pp.9848-17, (Released:2017-12-27)

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 CK level increased to 29,998 U/L. 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

Takeshi Numata Norihito Hida Kai Yazaki Naoki Arai Kyoko Ota Hidetoshi Yanai Takeo Endo

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.9399-17, (Released:2017-11-01)

参考文献数

23

被引用文献数

6

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A 39-year-old woman received a seasonal influenza vaccine in November 2015 and subsequently experienced malaise, low-grade fever, and chest discomfort. A chest X-ray performed 2 weeks after vaccination showed multiple nodular shadows in both lungs and ground-glass shadows in both lower lung fields. Her bronchoalveolar lavage fluid contained an unusually high number of lymphocytes, and a drug-induced lymphocyte stimulation test for seasonal influenza vaccine was positive. Transbronchial lung biopsy revealed the presence of granulomatous inflammation. Thereafter her abnormal chest shadow spontaneously improved. Based on these findings, the patient was diagnosed with drug-induced pneumonitis due to an influenza vaccine.