Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
46 巻, 13 号
選択された号の論文の27件中1~27を表示しています
ORIGINAL ARTICLES
  • Hidetaka Tsumura, Isamu Tamura, Hiroshi Tanaka, Ryo Chinzei, Tsukasa I ...
    2007 年 46 巻 13 号 p. 927-931
    発行日: 2007年
    公開日: 2007/07/02
    ジャーナル オープンアクセス
    Objective Recently guidelines for the treatment and prevention of ulcers induced by nonsteroidal anti-inflammatory drugs (NSAIDs) have been established. The aim of the present study was to examine factors influencing orthopedists in Japan in the use of cytoprotective drugs to prevent NSAID-associated gastrointestinal adverse events.
    Methods We sent a questionnaire to 402 orthopedists in Hyogo Prefecture. A standardized 10-item questionnaire was used to collect information on NSAID prescriptions (drug name, pharmaceutical form, doses, and duration of use) and associated drugs, especially gastroprotective drugs.
    Results Two hundred eight (51.7%) orthopedists returned the questionnaire. The most frequently used NSAIDs, in descending order, were loxoprofen sodium, diclofenac sodium, and etodolac. Most doctors (80%) reported patients with abdominal symptoms associated with NSAIDs. Of these doctors, 59% treated the symptoms by themselves, and prescribed gastroprotective agents (32.2%), histamine H2-receptor antagonists (H2RAs) (26.4%), prostaglandin analogues (PAs) (17.0%), or proton pump inhibitors (PPIs) (16.2%). Sixty-seven percent of doctors reported that those drugs reduced the symptoms. Most orthopedists (96%) prescribed some type of drug to prevent NSAID-associated gastrointestinal events, including gastroprotective drugs (44.6%), H2RAs (19.5%), PAs (17.4%), and PPIs (10.8%). The doctors reported that they prescribed medicines for NSAID-associated gastrointestinal events on the basis of their experience (23%), by considering medical insurance restrictions (17%), and by referring to information provided by pharmaceutical company representatives (16%).
    Conclusion Most orthopedists prescribe some type of drug to prevent NSAID-induced ulcers but do not refer to the guidelines. We therefore strongly recommend that the guidelines be made more widely known to gastroenterologists and to physicians in every field of clinical practice, including orthopedics.
  • Junzo Nagashima, Haruki Musha, Hideomi Takada, Naoki Matsumoto, Rikiya ...
    2007 年 46 巻 13 号 p. 933-936
    発行日: 2007年
    公開日: 2007/07/02
    ジャーナル オープンアクセス
    Object Recently, prothrombin fragment F1+2 was shown to be a sensitive direct marker of thrombin formation. We examined the effect of lifestyle (including physical activity) on prothrombin fragment F1+2 levels.
    Methods Using the results of a questionnaire, the subjects were classified into groups on the basis of multiple medications, smoking, exercise, and drinking alcohol. The prothrombin fragment F1+2 levels were compared between each pair of groups and differences were analyzed using the unpaired t-test. Correlations between each parameter and the systolic and diastolic blood pressure, as well as with prothrombin fragment F1+2, were examined by multiple regression analysis.
    Patients The subjects were 109 patients who had essential hypertension without a past history of thrombotic events
    Results Smokers (1.47 ± 0.75 vs 0.98 ± 0.46 nmol/L, p<0.0001), and those without regular exercise (1.22 ± 0.59 vs 0.68 ± 0.30 nmol/L, p<0.0001) had higher levels of prothrombin fragment F1+2. Age, lack of exercise, and smoking were significant predictors of a high concentration of prothrombin fragment F1+2. Of the smokers, the patient with a regular exercise had low F1+2 compared with those without regular exercise (0.75 ± 0.20 vs 2.01 ± 0.49 nmol/L, p<0.0001.
    Conclusions In patients with essential hypertension, age, smoking, and lack of regular exercise may increase the risk of thrombosis. Even in smokers, a regular exercise routine may reduce the tendency towards thrombus formation.
  • Ritsuko Yamamoto-Honda, Yoshihiko Takahashi, Yoko Yoshida, Yoko Hara, ...
    2007 年 46 巻 13 号 p. 937-943
    発行日: 2007年
    公開日: 2007/07/02
    ジャーナル オープンアクセス
    Objective To evaluate the results of treatment with an insulin glargine-based regimen as compared with those of an NPH insulin-based regimen.
    Methods We reviewed the charts of 83 Japanese patients with Type 1 diabetes treated with insulin glargine for 12 months.
    Patients Median age, 56.9 years (range, 24.6-74.8 years), mean (±S.D.) body mass index, 21.2 (±2.2) kg/m2.
    Results The average HbA1c level of the cohort was 7.8 ± 1.2% at baseline and 7.7 ± 1.0% at the end of the 12-month treatment (P=0.34). The average insulin requirement per day in the cohort remained unchanged after the 12-month treatment (35.0 ± 11.6 units/day versus 35.2 ± 11.2 units/day (P=0.58). Of the 36 patients who were receiving twice or three times daily injections of NPH insulin, 30 could be switched to a single-daily injection of insulin glargine. The frequency of severe hypoglycemia with unconsciousness became lower after switching to the insulin glargine-based regimen than during treatment with the NPH-based regimen. The average ratio of the daily usage of insulin glargine to that of total insulin after 12 months was smaller than that reported from other countries (0.34 ± 0.09).
    Conclusion These results obtained from a larger number of patients as compared to previous Japanese studies confirm earlier reports that insulin glargine provides equivalent glycemic control to human NPH insulin, with a lower incidence of severe hypoglycemia. Thus, treatment with insulin glargine provides some benefits to Japanese patients with Type 1 diabetes.
  • Zorica Rasic-Milutinovic, Gordana Perunicic, Steva Pljesa, Zoran Gluvi ...
    2007 年 46 巻 13 号 p. 945-951
    発行日: 2007年
    公開日: 2007/07/02
    ジャーナル オープンアクセス
    Objective Insulin resistance and metabolic syndrome (MeS) are common in end-stage renal disease (ESRD) patients on maintenance hemodialysis (HD). Such metabolic and clinical abnormalities may lead to an increased risk for cardiovascular disease.
    Methods The study group included 22 well-nourished and 20 middle- to moderate-malnourished, stable ESRD patients, with median dialysis duration of 48 months (IQR 24.5-82.0). To determine nutritional status, body composition, inflammatory biomarkers and the presence of MeS subjective global assessment (SGA), anthropometrical measurements (BMI and waist circumference), bioelectrical impedance analysis (BIA), and biochemical parameters [the levels of serum albumin, cholesterol, HDL-cholesterol, triglyceride, hematocrit, hemoglobin, iron, TIBC, transferrin saturation (TSAT), ferritin, calcium, phosphorus, intact parathormone (i-PTH), TNF-alpha, IL-6 and high sensitivity C-reactive protein (hs-CRP)] were used. All parameters were evaluated by comparisons between two groups, with MeS (Group 2) and without it (Group 1). Logistical regression analysis was used to evaluate the correlation between measured variables and the presence of MeS in HD patients. Independent variables for MeS were identified by backward multivariate regression analysis. To identify the independent predictors for insulin resistance index (HOMA-IR) multivariate regression analysis was conducted, after linear regression analysis.
    Results After adjustment for confounding variables, a model consisting of serum levels of iron, transferrin saturation (TSAT), and BMI which accounted for 62% of the variance in MeS, determined only BMI as an independent marker (according to ATP-III criteria). But, serum glucose level, iron, waist and total fat mass accounted for 68% of the variance in MeS, according to IDF critera. Glucose level was an independent predictor. BMI and iron, as independent variables, contributed to 29% of the variance in IR HOMA, the sensitive marker of MeS.
    Conclusion The present study demonstrated that serum iron participated together with independent predictors, glucose and BMI, in the pathogenesis of IR and MeS of ESRD patients on maintenance HD.
  • Masafumi Seki, Kosuke Kosai, Katsunori Yanagihara, Yasuhito Higashiyam ...
    2007 年 46 巻 13 号 p. 953-958
    発行日: 2007年
    公開日: 2007/07/02
    ジャーナル オープンアクセス
    Objective To determine the differences in the clinical features of bacterial pneumonia patients between patients co-infected with influenza virus or not co-infected.
    Methods Fifteen adult patients with bacterial pneumonia (7 men and 8 women) who also tested positive for influenza virus antigen were compared with those with bacterial pneumonia alone (n=28).
    Results Complications with chronic lung diseases were more frequently found in bacterial pneumonia patients with influenza virus infection, compared with those who had bacteria pneumonia alone. Statistical differences were also found in body temperature, and heart rates between the two groups. CRP levels, chest X-ray infiltrates and the severity of pneumonia, as determined using the criteria of the Japan Respiratory Society (JRS) and/or the Infectious Diseases Society of America (IDSA), were also significantly worse in patients of bacterial pneumonia infected with influenza virus, than in those who had bacterial pneumonia alone.
    Conclusions The severity of pneumonia in patients co-infected with influenza virus and bacteria was significantly higher than in those infected with bacteria alone. These data suggested that the influenza virus infection enhanced the bacterial pneumonia. Further study of the pathogenesis of the synergic interaction between influenza virus and bacteria is warranted.
  • Kosuke Suzuki, Takahiro Iizuka, Fumihiko Sakai
    2007 年 46 巻 13 号 p. 959-963
    発行日: 2007年
    公開日: 2007/07/02
    ジャーナル オープンアクセス
    Objective To evaluate the efficacy and tolerability of Botulinum Toxin Type A (BoNT-A) for migraine prophylaxis.
    Methods Nineteen Japanese adult patients (50 ± 10 years old), who met the International Classification of Headache Disorders 2nd Edition (ICHD II) criteria for migraine and had five or more migraine attacks a month, were enrolled in this open-label prospective study. A total of 50 units of BoNT-A were injected in 19-fixed sites of the muscles including procerus, corrugator, frontalis, temporalis and occipitalis. All participants were advised to stop taking preventive medicine from one month before and three months after BoNT-A injection. Migraine disability assessment (MIDAS), migraine questionnaire and headache diary were used for the evaluation of efficacy. Seven patients received repeated injection combined with prophylactic medication.
    Result We excluded five patients from the analysis because four patients had medication overuse headache and one continued preventive medicine. Mean MIDAS score decreased significantly two months after the injection. Thirteen of 14 patients stated subjective improvement after the injection on the migraine questionnaire. The amount of analgesics consumption or headache frequency did not change after injection, but the frequency of severe migraine attacks decreased significantly. No serious adverse event was reported. Repeated injections also showed significant reduction in MIDAS score three months after the second and third injections.
    Conclusion BoNT-A injection was an effective and safe treatment for migraine prophylaxis among the Japanese population. A randomized placebo control trial is necessary to confirm its efficacy.
  • Yusuf Yurumez, Polat Durukan, Yucel Yavuz, Ibrahim Ikizceli, Levent Av ...
    2007 年 46 巻 13 号 p. 965-969
    発行日: 2007年
    公開日: 2007/07/02
    ジャーナル オープンアクセス
    Objects In the present study, we evaluated patients who were admitted to our emergency department with a diagnosis of organophosphate poisoning and discussed clinical, social and demographic features.
    Methods A retrospective study was conducted with organophosphate poisoning patients admitted to our emergency department between January 1995 and December 2004. Data regarding the age, sex, occupation, type of agent, route of poisoning, clinical effects of cholinergic overactivity, laboratory findings, and mortality rate were obtained from the patient files.
    Results During the study period, 220 patients who had organophosphate poisoning with a known agent were admitted to the ED. The estimated mean admission time to the ED after the exposure was 3.9 ± 3.1 (1-14) hours. There were 131 (59.5%) female and 89 (40.5%) male patients. The most affected age group was 15-24 years (40.5%), in both sexes. Oral ingestion (86.5%) was found to be the most common route of poisoning. The most frequent reason for poisoning was attempted suicide (75.9%). The most common organophosphate compounds exposed were dichlorvos, diazinon and parathion-methyl. The most frequent clinical signs were miosis, respiratory system findings, tachycardia, loss of consciousness, and hypertension. Twenty patients (9.1%) died due to sudden respiratory and cardiac arrest (45%), respiratory failure (25%), CNS depression (5%) and septic shock (25%).
    Conclusion We think that the appropriate use of these compounds, instruction of the public about their harmful effects and restriction of their uncontrolled sales by legal regulations can reduce the incidence of organophosphate poisoning.
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