Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
46 巻, 8 号
選択された号の論文の27件中1~27を表示しています
EDITORIAL
ORIGINAL ARTICLES
  • Terumi Kamisawa, Yuyang Tu, Ryoko Sasaki, Naoto Egawa, Noriko Kamata, ...
    2007 年 46 巻 8 号 p. 435-440
    発行日: 2007年
    公開日: 2007/04/17
    ジャーナル オープンアクセス
    Objective: To compare salivary gland function in autoimmune pancreatitis (AIP) patients with and without an elevated serum IgG4 concentration.
    Patients and Methods: We allocated 14 AIP patients into 2 groups: one group had high (>135 mg/dL) serum IgG4 and the other low serum IgG4. Sialochemistry and submandibular and parotid gland scintigraphy were done in these patients.
    Results: Serum IgG4 levels were elevated in 10 patients. Bilateral submandibular gland swelling was present in 5 patients with a high serum IgG4; there was no swelling in patients with a low serum IgG4. The salivary Na+ concentration was increased significantly in both patient groups (p<0.01) compared to controls. The β2-microglobulin concentration was significantly higher in patients with a high serum IgG4 than in those with a low serum IgG4 (p<0.05) and controls (p<0.01). On submandibular and parotid gland scintigraphy, both the ratio of the cumulative peak count to the injected radionuclide (PCR) and the washout ratio (WR) were significantly lower in the high serum IgG4 group than in controls (p<0.01). In the low serum IgG4 group, the PCR on submandibular gland scintigraphy, and the PCR and WR on parotid gland scintigraphy were significantly lower than in controls (p<0.05, p<0.01 and p<0.05, respectively). On submandibular gland scintigraphy, the PCR was significantly lower in the high serum IgG4 group than in the low serum IgG4 group (p<0.05).
    Conclusions: Salivary gland function was impaired in all AIP patients, but it was more impaired in patients with a high serum IgG4 than in those with a low serum IgG4.
  • Xin-Liang Lu, Jian-Ting Cai, Xing-Guo Lu, Jian-Min Si, Ke-Da Qian
    2007 年 46 巻 8 号 p. 441-446
    発行日: 2007年
    公開日: 2007/04/17
    ジャーナル オープンアクセス
    Background: The potential to predict pancreatic necrosis within the first 48 h by using plasma soluble thrombomodulin (sTM) in 104 patients with acute pancreatitis (AP) was analyzed in a prospective 5-year investigation performed at a single institution.
    Methods: According to Balthazar CT grade, pancreatitis was classified as no necrosis in 72 patients, one-third necrotic in 18 patients, one-half necrotic in 10 patients and more than one-half necrotic in 4 patients. Blood was collected at the first 48 hours after the onset of pain and analyzed for sTM.
    Results: In the healthy volunteers, plasma levels of TM were 16.49±5.24 μg/L. By comparison, the mean plasma levels of TM in each group of pancreatitis patients were as follows: CT grade A group, 34.21±10.73 μg/L; CT grade B group, 36.18±12.50 μg/L; CT grade C group, 49.39±18.38 μg/L; CT grade D group, 114.46±39.44 μg/L; CT grade E group, 100.22±15.97 μg/L (p<0.01). And for the patients, the Pearson correlation coefficient between the CT grade and TM values was 0.784 (p<0.01). No necrosis group, 39.22±13.75 μg/L; one-third necrotic group, 71.44±18.02 μg/L; one-half necrotic group, 123.50±28.57 μg/L; more than one-half necrotic group, 129.00±33.28 μg/L (p<0.01); And for the patients, the Pearson correlation coefficient between the degree of necrosis and TM values was 0.888 (p<0.01). ROC analysis indicated the area under the ROC curve (AUC ± SE) for sTM was 0.949±0.020, clearly supportive of the high accuracy of this index in predicting the necrosis of AP.
    Conclusion: Plasma soluble thrombomodulin (sTM) is a potential marker to predict pancreatic necrosis within the first 48 h, and further investigation in a multicentre study is necessary.
  • Yasunori Iwata, Takashi Wada, Hitoshi Yokoyama, Tadashi Toyama, Shinji ...
    2007 年 46 巻 8 号 p. 447-452
    発行日: 2007年
    公開日: 2007/04/17
    ジャーナル オープンアクセス
    Background: In hemodialysis patients, adynamic bone disease has been reported to be closely associated with low levels of parathyroid hormone (PTH) due to exposure to high levels of serum calcium following the administration of calcium carbonate (CaCO3) or vitamin D agents. This study was conducted to clarify the therapeutic effect of a non-calcemic phosphate binder, sevelamer hydrochloride (sevelamer), for hypoparathyroidism in hemodialysis patients with or without diabetes mellitus.
    Methods: Based on entry criteria, 40 Japanese chronic hemodialysis patients (22 males and 18 females with a mean age of 60.6, 14 diabetic patients and 26 non-diabetic patients) were switched from CaCO3 to sevelamer for 48 weeks. Serum calcium, phosphate, intact (i) PTH and PTH-(1-84) were analyzed. Bone remodeling activity was evaluated by determining intact osteocalcine (iOC), bone-specific alkaline phosphatase (BAP).
    Results: The switch from CaCO3 to sevelamer significantly decreased the serum levels of calcium, resulting in the elevation of iPTH levels from 31±18 pg/mL to 95±96 pg/mL by 48 weeks. In contrast, serum phosphate levels remained similar to those in patients with CaCO3 treatment. Concomitantly, the levels of BAP and iOC were elevated. Further, these beneficial effects on bone turnover were observed in both diabetic and non-diabetic patients.
    Conclusion: Sevelamer reduced the calcium concentration and thereby increased PTH levels, resulting in the improvement of markers of bone turnover. The administration of sevelamer is of therapeutic benefit for the improvement of bone remodeling activity even in hemodialysis patients with diabetes.
  • Masaki Takahashi, Shigeru Otsubo, Keiko Uchida, Wako Yumura, Kosaku Ni ...
    2007 年 46 巻 8 号 p. 453-460
    発行日: 2007年
    公開日: 2007/04/17
    ジャーナル オープンアクセス
    Objective: Adiponectin has attracted great attention because of its anti-atherogenic properties; however, to date the relationship between serum adiponectin and arteriolosclerosis has not been reported. In our study, we aimed to examine whether or not serum adiponectin levels are associated with arteriolosclerosis in patients with IgA nephropathy which is the most common form of chronic glomerulonephritis.
    Materials and Methods: We enrolled 35 patients aged 35.0±14.6, who underwent renal biopsy from August 2004 to February 2006 in our hospital, and were confirmed to have IgA nephropathy. We examined serum adiponectin, high-sensitive C-reactive protein, total cholesterol and triglyceride level, urinary protein excretion, body mass index (BMI), and the presence of arteriolosclerosis in the renal specimens. Since the serum adiponectin level is strongly affected by renal function, we classified the patients by creatinine clearance.
    Results: Multiple regression analysis showed the associations of adiponectin with creatinine clearance (p<0.001), BMI (p<0.001), serum triglyceride (p=0.001) and urinary protein excretion (p=0.001). We observed a positive relation of adiponectin with urinary protein excretion and an inverse relation of adiponectin with creatinine clearance, serum triglyceride, and BMI. We could not detect any relation between the presence of arteriolosclerosis and adeponectin in the IgA nephropathy patients as a whole; however, in patients whose creatinine clearance was 90-120 ml/min/1.73 m2, the serum adiponectin level of patients with arteriolosclerosis was lower than in those without arteriolosclerosis (p=0.025).
    Conclusion: The serum level of adiponectin was related to arteriolosclerosis in IgA nephropathy patients whose renal function was almost normal. Adiponectin may prevent renal arteriolosclerosis.
  • Eiichiro Sugihara, Takashi Dambara, Miyoji Aiba, Masaki Okamoto, Junko ...
    2007 年 46 巻 8 号 p. 461-466
    発行日: 2007年
    公開日: 2007/04/17
    ジャーナル オープンアクセス
    Legionella spp are well recognized as one of the etiologic factor in pneumonia, but it is difficult to distinguish the clinical features of Legionella infection from pneumonia due to other causes. The objective of the present study was to examine the clinical characteristics of community-acquired Legionella pneumonia in elderly patients. We reviewed the clinical, laboratory and radiographic findings in 8 patients diagnosed as having pneumonia caused by Legionella. The diagnosis was confirmed by the presence of urinary antigen, bacterial culture, polymerase chain reaction (PCR) and serum antibody. There were 6 men and 2 women, whose ages ranged from 76 to 85 years. All patients had fever and hypoxia, four patients had respiratory symptoms. The initial chest X-ray findings were varied-consolidation, ground glass opacity, pleural effusion and linear shadow. Urinary antigen was positive in 4 patients, bacterial culture in 2, PCR on the sputum in 3 and serum antibody in 2 patients. As pneumonia caused by Legionella often becomes life-threatening, especially in elderly people, it is imperative to diagnose it at the initial stage. In this study, urinary antigen proved to be the most useful diagnostic means. However, it is important to confirm the diagnosis through plural examinations.
  • Koichi Hirata, Muneto Tatsumoto, Nobuo Araki, Takao Takeshima, Hisaka ...
    2007 年 46 巻 8 号 p. 467-472
    発行日: 2007年
    公開日: 2007/04/17
    ジャーナル オープンアクセス
    Objective: Benzodiazepines are commonly used for the treatment of tension-type headache (TTH), however, there are few randomized controlled trials recommending the use of these drugs in Japan. This study was undertaken to evaluate the efficacy of etizolam, a thienodiazepine derivative, in combination with a non-steroidal anti-inflammatory drug (NSAID) as an acute treatment for TTH.
    Methods: The study design was a multi-center randomized control trial and included 144 patients. The diagnosis of TTH was based on the criteria of the International Classification of Headache Disorders-1 and all patients were diagnosed with episodic tension-type headache (ETTH). Changes in the severity of headache and shoulder pain were graded using a Visual Analogue Scale (VAS) before and after administration of drugs. Patients were randomized into NSAID alone (NSAID, mefenamic acid, 250 mg)group and NSAID (mefenamic acid, 250 mg) plus etizolam (0.5 mg) (NSAID-ET) group prior to treatment.
    Results: Although both groups showed a significant drop in VAS for headache and shoulder pain (p<0.01), there was no overall significant difference between the NSAID-ET and NSAID groups. However, headache was improved significantly in female patients (p<0.05), and shoulder pain was improved in young and female patients (p<0.05, p<0.04) in the NSAID-ET group.
    Conclusion: This study indicates that the combination treatment of etizolam and NSAID is useful in young or female patients.
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