著者

Ayami Ochi Takashi Takei Kayu Nakayama Chihiro Iwasaki Daigo Kamei Yuki Tsuruta Ari Shimizu Shunji Shiohira Takahito Moriyama Mitsuyo Itabashi Toshio Mochizuki Keiko Uchida Ken Tsuchiya Motoshi Hattori Kosaku Nitta

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.51, no.7, pp.759-762, 2012 (Released:2012-04-01)

参考文献数

15

被引用文献数

17 21

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We present two cases with steroid-resistant nephrotic syndrome (SRNS) and two cases with steroid-dependent nephrotic syndrome (SDNS) due to focal segmental glomerulonephritis (FSGS) who were treated with a single dose of rituximab (375 mg/m2). Although the two cases with SRNS showed no response, the two cases with SDNS achieved complete remission. The patients in whom the peripheral B-cell counts subsequently increased after the administration of rituximab demonstrated a relapse. Rituximab may be an effective treatment agent for SDNS with FSGS and the peripheral B-cell count may be a useful marker in such patients for preventing disease relapse.

著者

Yusuke Fukuda Shin-ichiro Miura Keijiro Saku

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.51, no.4, pp.441-442, 2012 (Released:2012-02-15)

参考文献数

1

被引用文献数

1 1

著者

Kojiro Sato Toshihide Mimura

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.51, no.4, pp.451, 2012 (Released:2012-02-15)

著者

田辺 晃久 本間 康彦 兼本 成斌 日野原 茂雄 五島 雄一郎

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.73, no.3, pp.323-331, 1984

被引用文献数

2 1

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試作体位センサーによる体位情報とホルター心電図との同時記録から,虚血ST-T変化と体位ST-T変化との鑑別を試みた.対象は陳旧性心筋梗塞(OMI) 16名,狭心症(AP) 16名,健常例11名の計43名であつた.虚血ST変化はOMIで3/21件(14%), APで29/35 (83%)とAPに多く,体位ST変化はOMIで13/21 (62%), APで5/35 (14%)とOMIに多かつた.最大ST変化に至る時間は体位ST変化では10秒以内が18/25 (72%)と大多数を占めたのに対し,虚血ST変化では1分以上が28/32 (88%)と大多数を占めた.体位T変化についても10秒以内が15/18 (83%)と大多数を占めたのに対し,虚血T変化では10秒以内はわずか2/13 (15%)ときわめて少なかつた. CM₅誘導における体位ST変化の20/22 (91%), T変化の19/21 (90%)は体位変換前後で標準12誘導心電図のV₄, V₅, V₆のいずれかに対応して変化した.すなわち,これらの変化の原因は心軸回転で説明可能であつた.しかし,体位ST-T変化のうちST変化で2/22 (9%), T変化で2/21 (10%)は心軸回転で説明不能であつた. ST-T変化前に対する変化後の心拍数増加率(HR比)は虚血ST-T変化では高値例が多く,体位ST-T変化では少なかつた.とくにT変化でHR比1.3以上は虚血T変化の12/16 (75%)に対し,体位T変化では3/21 (14%)ときわめて少なかつた.以上より,ホルター心電図法の体位ST-T変化の虚血ST-T変化に対する鑑別点として, (1)ST-T丁変化の最大に至る時間, (2)標準12誘導心電図との比較, (3)心拍数増加の有無などの検討が重要と考えられた.

著者

Kohno Shigeru Seki Masafumi Watanabe Akira the CAP Study Group

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.50, no.11, pp.1183-1191, 2011-06-01

被引用文献数

36

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Objective The Japanese Respiratory Society (JRS) last revised the guidelines for community-acquired pneumonia (CAP) in adults in 2005. These guidelines proposed new criteria (A-DROP) to assess the severity of pneumonia and to differentiate between typical bacterial pneumonia and atypical pneumonia. The goal of the present study was to evaluate the utility of the A-DROP criteria for these described purposes. Methods An observational survey was conducted between July 2006 and March 2007, and patients with CAP were prospectively surveyed using consecutive enrollment methods. Patients In total, 1,875 patients from 200 medical facilities throughout Japan were analyzed. Results The JRS 2005 A-DROP system was a good indicator of mortality in the patient population, and these results were significantly correlated with the Pneumonia Severity Index (PSI) of the Infectious Disease Society of America (IDSA). Among the various factors characterized, 'SpO2 of 90% or less (PaO2 of 60 Torr or less)' was the strongest predictor of mortality. In terms of the differential diagnosis between typical bacterial and atypical pneumonia, five of six JRS 2005 items were strongly and significantly correlated with a diagnosis of atypical pneumonia. Conclusion The JRS 2005 A-DROP system was accurate and clinically useful for the assessment of the severity of pneumonia and for the differentiation between typical bacterial pneumonia and atypical pneumonia.

著者

細谷 泰久 西田 修 原田 秀樹 日下 輝年 波田 重英 坂 洋一 堀井 充 大野 辰治 杉山 建生 井上 文彦 中井 妙子 水本 孝 古川 裕夫

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.84, no.2, pp.298-300, 1995-02-10

被引用文献数

3

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症例は生来健康な32歳男性.平成5年1月30日早朝より右上腹部痛を自覚し当院受診.血液,尿検査にて白血球11100/μl,逸脱膵酵素の上昇(血中アミラーゼ3128U,尿中アミラーゼ65000U)を認め,腹部USおよびCT検査で膵頭部の腫大,上腸間膜静脈から門脈本幹に拡がる血栓を認めた.急性膵炎及びそれに伴う門脈血栓症と診断し,膵炎の治療と並行してヘパリンの投与を行い門脈血栓の消失を確認した.急姓膵炎の経過観察において腹部USおよびCT検査が有用であるが,その実施に当たっては,門脈血栓の合併の可能性をも考慮する必要があると思われた.

著者

若田 宣雄 里吉 営二郎 木下 真男 高沢 靖紀

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.64, no.12, pp.1399-1404, 1975

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症例: 19才女子,会社員. 17才頃,ソフトボールの試合中,休んでいたら右上下肢の脱力が出現,約1日で回復したが,その後,運動後休息中によく脱力発作が起きるようになり,また,スイカを食べて少ししても起きるようになつた.父親も同じようにスイカを食べると脱力発作が生じるという.入院時,四肢近位筋のごく軽度の脱力と,わずかな叩打後筋不随意収縮を認めた. KCI5g経口投与により,血清カリウムは最高7.5mEq/<i>l</i>に達し,腰がふちつき,歩行困難となつた.また, 30分間,自転車をこいだのち休息していると,血清カリウムは3.7から4.7までしか上昇しなかつたが,やはり脱力発作が出現した.一方,ブドウ糖およびインスリン負荷試験では,血清カリウムは4.7から3.6まで変化したが,脱力発作は見られなかつた. acetazolamide 1g/日連続投与でも麻痺は起こらず,これらの結果から,家族性高カリウム血性四肢麻痺と診断した.しかし,麻痺は高カリウム血の時にのみ起きるとは限らず,過去にも,正カリウム血性として報告されたものが,のちに高カリウム血性として再報告されたこともあり,両者の区別は必ずしも本質的ではないと考えた.また, acetazolamideに対する態度などから,低カリウム性のものとも一部には共通点を有する面もあり,血清カリウム濃度の相違からのみ,周期性四肢麻痺の発現機序を論じることは正しくないのではないかと考えた.

著者

Satoshi Kurisu Ichiro Inoue Takuji Kawagoe Masaharu Ishihara Yuji Shimatani Takaki Hata Yasuharu Nakama Yasufumi Kijima Eisuke Kagawa

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.45, no.10, pp.703-704, 2006 (Released:2006-06-15)

被引用文献数

6 5

著者

Takashi Kajiya Atsushi Kuroda Daisuke Hokonohara Chuwa Tei

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.45, no.13, pp.827-829, 2006 (Released:2006-08-01)

参考文献数

8

被引用文献数

2 3

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An 87-year-old man with heart failure caused by severe anemia was referred to our hospital. Gastroenteroscopy revealed the existence of several parasites in the duodenum. Examination of the stool by a formalin-ethyl acetate concentration technique detected hookworm eggs. After a single dose of pyrantel pamoate, his symptoms including dyspnea on exertion and edema diminished. And also hemoglobin and B-type natriuretic peptide (BNP) had improved dramatically. Hookworm infection is an extremely rare cause of heart failure, and furthermore this parasitic infection is not common in advanced countries. We suggest the possible relationship between parasite infection and organic foods.

著者

Hajime Fukuyama Tadashi Ishida Hiromasa Tachibana Hiroaki Nakagawa Masahiro Iwasaku Mika Saigusa Hiroshige Yoshioka Machiko Arita Toru Hashimoto

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.1917-1922, 2011 (Released:2011-09-15)

参考文献数

22

被引用文献数

3 12

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Objective Several scoring systems have been derived to identify patients with severe community-acquired pneumonia (CAP). Recently, España et al (Am J Respir Crit Care Med 174:1249-1256, 2006) developed a clinical prediction rule that predicts hospital mortality, the need for mechanical ventilation, and risk for septic shock. We assessed the performance of this rule and compared it with other published scoring systems. Methods A prospective study was conducted of patients with CAP who were hospitalized at our hospital from April 2007 till May 2009. Clinical and laboratory features at presentation were recorded and used in order to calculate España rule, the pneumonia severity index (PSI), CURB-65, A-DROP, the 2007 Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) prediction rule and SMART-COP. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were compared for adverse outcomes. We also assessed the association of the España rule criteria and adverse outcomes. Results A total of 505 patients were enrolled in the study. The overall in-hospital mortality rate was 6.5%, and 6.3% of patients were admitted to the intensive care unit (ICU). Sixty-two (12.3%) patients were defined as having severe CAP (in-hospital death or need for mechanical ventilation or septic shock). España rule achieved highest sensitivity and NPV in predicting severe CAP. When ICU admission was the outcome measure, the IDSA/ATS rule and SMART-COP were regarded to be good predictors. Conclusion España rule performed well in identifying patients with severe CAP. As a result, each of the severity scores has advantages and limitations for predicting adverse outcomes.

著者

西川 政勝 渡辺 泰行 市岡 希典

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.89, no.6, pp.1054-1061, 2000-06-10

被引用文献数

2 1

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止血血栓と異なり,病的血栓である動脈血栓症は,粥腫プラークのびらんまたは破壊とそれに伴う血栓形成により動脈閉塞や狭窄をきたす疾患で,その初期病変は速い流れの中で生ずる血小板血栓である.内皮細胞が傷害されると内皮下組織に血小板がずり速度依存性に粘着・凝集し,種々の生理活性物質を放出し,血管内腔に向かう壁在血栓が形成される.これらの反応にはvon Willebrand因子が重要な役割を演じていると考えられる.血小板は,動脈血栓形成初期に中心的役割を演じているばかりでなく,動脈硬化の進展にも密接に関係している.各種の抗血小板剤が開発され動脈血栓症の再発予防ばかりでなく急性期の虚血性疾患の治療にも用いられている.深部静脈血栓症では,血流のうっ帯などがトリガーとなり血液凝固の活性化に伴うフィブリン血栓が主体であるが,血小板も関与すると考えられる.

著者

秋山 哲雄 中本 安 三浦 亮

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.73, no.6, pp.871-875, 1984

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子宮頚癌により広範性子宮全摘術後,両側性水腎症,腎性尿崩症を呈し,間歇的自己導尿法により改善をみた1症例を経験したので報告する.症例は48才,女性. 43才の時,子宮頚癌(病期I)にて広範性子宮全摘術を受けた. 1982年6月頃から口渇,多飲および1日4~6<i>l</i>におよぶ多尿が出現し,精査のため1982年8月2日当科入院.身体的には皮膚はやや乾燥し,軽度の脱水傾向がみられる以外には異常所見なし.検査では尿糖陰性,尿比重1.004,血清Na 150mEq/<i>l</i>, K 3.4mEq/<i>l</i>, Cl 124mEq/<i>l</i>.耐糖能異常なし.眼底,視野異常なし.水制限試験では尿浸透圧の上昇はみられず高張食塩水負荷(Carter-Robins試験)でも尿量,自由水クリアランスの減少なし.ピトレシン5Uの投与でも尿量,尿浸透圧に変化はみられなかつた.血漿ADH 2.9pg/ml.トルコ鞍X線像異常なし.排泄性腎盂造影では両側性水腎症の所見を呈す. urodynamic studyでは多量の残尿がみられ, areflexic neurogenic bladderで両側IV度のvesicoureteral reflux (VUR)を認めた.以上よりneurogenic bladder, VUR,水腎症,腎性尿崩症と進展したものと診断した.治療は,サイアザイド剤の投与および間歇的自己導尿法を指導し, 1日6~7回の自己導尿を行ない残尿量は減少し,尿量は1日約2<i>l</i>と改善をみている.類似症例は国内外にみられず,その成因と病態についても言及した.

著者

Hideto Kameda Hitoshi Tokuda Fumikazu Sakai Takeshi Johkoh Shunsuke Mori Yuji Yoshida Noboru Takayanagi Hirofumi Taki Yoshinori Hasegawa Kazuhiro Hatta Hisashi Yamanaka Makoto Dohi Shu Hashimoto Hidehiro Yamada Shinichi Kawai Tsutomu Takeuchi Kazuhiro Tateda Hajime Goto

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.50, no.4, pp.305-313, 2011 (Released:2011-02-15)

参考文献数

25

被引用文献数

27 60

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Objective Acute-onset diffuse interstitial lung disease (AoDILD) in patients with rheumatoid arthritis (RA) has been a serious concern, especially for those under treatment with biological agents which may affect the presentation and outcome of AoDILD, including Pneumocystis pneumonia (PCP). Therefore, we conducted a retrospective, multi-center study of AoDILD in RA patients receiving biological agents. Methods Patients who developed AoDILD while receiving biological agents (infliximab, etanercept, adalimumab and tocilizumab) were enrolled in the study. Definite PCP was defined as patients who showed either P. jirovecii organisms in their respiratory samples by microscopic examination, or positive tests for both P. jirovicii DNA-PCR with respiratory samples and an elevated serum 1,3-β-D-glucan level above the cut-off value. Probable PCP was defined as either a positive test for P. jirovicii PCR or an elevated serum β-D-glucan level. Chest HRCT findings were evaluated and scored by two board-certified radiologists. Results The final diagnoses for 26 patients examined were definite PCP for 13 patients, probable PCP for 11, and methotrexate-associated pneumonitis in 2 patients. Definite and probable PCP cases were clinically indistinguishable. Generalized, diffuse ground-glass opacity (GGO) is the characteristic HRCT finding in patients with definite or probable PCP, which was different from our previous findings in RA patients, mostly without biologics, showing GGO distributed in a panlobular or multilobular manner. The clinical outcome was favorable by treatment with trimethoprim-sulfamethoxazole and glucocorticoids. Conclusion The possibility of PCP should be intensively investigated in RA patients developing AoDILD while receiving biological agents.

著者

檜山 桂子

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.2, pp.534-539, 2011-02-10

被引用文献数

1

著者

Aygul Dogan Celik Yahya Celik Zerrin Yulugkural Kemal Balci Ufuk Utku

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.47, no.23, pp.2091-2093, 2008 (Released:2008-12-01)

参考文献数

6

被引用文献数

3 6

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Brucellosis is a zoonosis that is transmissible to humans. It is a disease with multi-systemic involvement caused by the genus Brucella. Neurological complications, including meningitis, meningo-encephalitis, myelitis-radiculoneuritis, brain abscess, epidural abscess and meningo-vascular syndromes, are rarely encountered. We present a patient presenting with acute onset myositis. This kind of presentation has not previously been reported in the English language literature. We conclude that the diagnosis of neuro-brucellosis should be considered in patients presenting with muscle weakness.

著者

加藤 孝宣 高橋 和明

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.11, pp.2418-2422, 2007-11-10

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この数年間でE型肝炎に関する常識は大きく変化した.かつては輸入感染症であったはずのE型肝炎は,今や国内感染の頻度が輸入感染を遥かに上回っている.そして国内感染の主な感染経路が動物由来であることが明らかとなってきた.鹿・猪・豚の肉や内臓を非加熱,あるいは不充分加熱状態で食することによりE型肝炎が起こり得る.原因不明の急性肝炎症例ではE型肝炎も選択肢の一つとして認識すべきである.<br>

著者

小野江 和之 河合 聖子 丹羽 さやか 八木 健郎 馬場 研二 山口 悦郎

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.96, no.11, pp.2519-2521, 2007-11-10

被引用文献数

1 1

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症例は61歳,女性.持続する微熱,乾性咳嗽あり当科受診した.外来検査中に症状増悪し緊急入院,自然経過のみで自他覚所見の改善を認めた.過敏性肺炎を疑い精査したが血清学的には抗原同定困難であった.誘発試験にて羽毛布団に原因抗原が含まれることを確認した.<br>

著者

Nobue Yagihara Akinori Sato Hiroshi Furushima Masaomi Chinushi Takashi Hirono Yoshifusa Aizawa

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.49, no.18, pp.1979-1982, 2010 (Released:2010-09-15)

参考文献数

19

被引用文献数

9 9

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A 75-year-old man was admitted to our hospital in January 2010 for evaluation of syncope and abnormal ECG. ECG showed type 1 ST elevation in lead V1 and he was diagnosed as Brugada syndrome. During cardiac catheterization, baseline coronary angiography was normal, but intracoronary ergonovine maleate induced spasms of the right and left coronary arteries concomitant with chest pain and ST elevation on ECG. J waves were accentuated or newly developed. Soon after an intracoronary injection of nitroglycerin, chest pain was relieved and ischemia-induced J wave disappeared and the ST segment returned to the same morphology as baseline. Extrastimuli induced ventricular fibrillation. He received an implantable cardioverter-defibrillator. He was also treated with Ca antagonist and isosorbide dinitrate and has had an uneventful course for 5 months.

著者

Yoshio Yamaoka Mototsugu Kato Masahiro Asaka

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.47, no.12, pp.1077-1083, 2008 (Released:2008-06-16)

参考文献数

77

被引用文献数

84 168

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Certain populations with high incidences of Helicobacter pylori infection, such as those in East Asian countries, have high incidences of gastric cancer, while other highly infected populations, such as those in Africa and South Asia, do not. The various rates of gastric cancer associated with different geographic areas can be explained, at least in part, by the differences in the genotypes of H. pylori cagA and vacA. Populations expressing a high incidence of gastric cancer are mostly identical with regions where East Asian type CagA is predominant. In contrast, incidence of gastric cancer is low in Africa, South Asia, and Europe, where strains typically possess Western type CagA. Within East Asia, strains from northern parts, where the incidence of gastric cancer is high, predominantly possess the vacA m1 genotype, whereas the m2 genotype is predominant in southern parts where the gastric cancer incidence is low.

著者

Kiminobu Tanizawa Kentaro Fukunaga Noriko Okumura Mitsuko Sugimura Eisaku Tanaka Takashi Hajiro Minoru Sakuramoto Masayoshi Minakuchi Seishu Hashimoto Takehiro Yasuda Yusuke Kaji Kohei Ikezoe Eizaburo Sato Toshifumi Nakajima Yoshio Taguchi

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.49, no.12, pp.1179-1183, 2010 (Released:2010-06-15)

参考文献数

26

被引用文献数

3 3

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A standard treatment has not yet been established for elderly small-cell lung cancer patients, especially when they have end-stage renal disease. We report the first case of successful chemoradiotherapy in an elderly small-cell lung cancer patient undergoing continuous ambulatory peritoneal dialysis. A 77-year-old Japanese man on continuous ambulatory peritoneal dialysis was diagnosed as having limited disease small-cell lung cancer. He received four monthly cycles of chemotherapy consisting of carboplatin at 240 mg/m2 on day 1 and etoposide at 40 mg/m2 on days 1 and 3. He underwent additional hemodialysis on days 1 and 3, while continuous ambulatory peritoneal dialysis continued as usual on the other days. Following chemotherapy, he underwent hyperfractionated radiotherapy to a total dose of 45 Grey, resulting in complete remission of the disease. A pharmacokinetic study showed an area under the concentration-time curve of carboplatin of 3.41 to 4.88 mg·min/mL, increasing gradually over the first three cycles, while etoposide did not show this gradual increase. The increased area under the concentration-time curve of carboplatin may have reflected a worsened renal function during chemotherapy. Despite dose reductions and favorable areas under the concentration-ime curve of carboplatin, the patient suffered grade 3-4 hematological toxicities, necessitating transfusions and a further dose reduction. The patient died of recurrent small-cell lung cancer 19 months after diagnosis.