Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
47 巻, 17 号
選択された号の論文の10件中1~10を表示しています
ORIGINAL ARTICLES
  • Takuma Tajiri, Genshu Tate, Katsutoshi Miura, Shinji Masuda, Nobuyuki ...
    2008 年 47 巻 17 号 p. 1499-1504
    発行日: 2008年
    公開日: 2008/09/01
    ジャーナル オープンアクセス
    Objective To analyze a risk factor for the onset of fulminant bacterial infection.
    Patients and Methods Nine unexpected acute death cases were clinicopathologically analysed. All cases represented the sudden onset of shock symptom, led to acute death within a few days, and later bacteremia was identified. Pathogens were Streptococcus pneumoniae (S. pneumoniae) (5 cases), group A beta Hemolytic Streptococcus pyogenes (S. pyogenes) (3 cases), and Vibrio vulnificus (V. vulnificus) (1 case).
    Results Seven of the nine patients had underlying chronic illness. S. pneumoniae infection was associated with splenic dysfunction, and group A beta Hemolytic S. pyogenes and V. vulnificus infections were associated with alcoholic liver injury. Group A beta hemolytic S. pyogenes and V. vulnificus infections involved necrotizing fasciitis, and alcoholic liver cirrhosis was confirmed in two of the four patients.
    Conclusion Despite the different type of bacteria, the onset of fulminant bacterial infection depended upon depressed bacterial phagocytosis in the liver or spleen. Underlying chronic illnesses should be identified as a predisposing common risk factor. It is important to understand the relations between underlying chronic illness and the onset of fulminant infection.
  • Yukako Sawara, Takashi Takei, Keiko Uchida, Tetsuya Ogawa, Takumi Yosh ...
    2008 年 47 巻 17 号 p. 1505-1510
    発行日: 2008年
    公開日: 2008/09/01
    ジャーナル オープンアクセス
    Objective Although previous studies suggest that treatment of dyslipidemia with statins reduces mortality and morbidity that are associated with cardiovascular disease, only a few studies have examined the efficacy of statins on atherosclerotic status in patients with chronic kidney disease (CKD).
    Materials and Methods A 12-month, prospective, randomized study was designed to assess the efficacy of rosuvastatin in reducing circulating atherosclerotic parameters and renal function in patients with CKD. Thirty-eight patients with CKD and LDL cholesterol levels ≥100 mg/dL were randomly assigned to receive 2.5 mg/dL rosuvastatin (group A, n=22) or nonrosuavastatin therapy (group B, n=16). Lipid profile, estimated glomerular filtration rate (eGFR), high sensitivity C-reactive protein (hs-CRP), and intima-media thickness (IMT) were measured before and 12 months after rosuvastatin was added to the treatment.
    Results Total cholesterol, low-density lipoprotein cholesterol, remnant-like particle-cholesterol and triglycerides were significantly reduced only in patients who received rosuvastatin. These parameters remained unchanged in patients who were not treated with rosuvastatin. eGFR was significantly increased from 50.7±18.7 mL/min/1.73 m2 to 53.3±20.1 mL/min/1.73 m2 and a significant reduction of U-P was detected in group A patients (0.17±0.29 vs. 0.13±0.3 g/day; p<0.01). In addition to the hypolipidemic effect, rosuvastatin treatment significantly reduced hs-CRP (p=0.0054). Moreover, maximal IMT at the baseline (1.89±0.98 mm) decreased significantly to 1.75±0.87 mm at 12 months (p=0.0231).
    Conclusion Rosuvastatin treatment, in addition to its beneficial effect on cholesterol levels, reduced maximal IMT and modified the inflammatory state of these patients.
  • Fatma Ayerden Ebinç, Ebinç Haksun, Derici Boztepe Ü ...
    2008 年 47 巻 17 号 p. 1511-1516
    発行日: 2008年
    公開日: 2008/09/01
    ジャーナル オープンアクセス
    Objective The existence of microalbuminuria (MAU) in patients with essential hypertension is a strong indicator of microvascular damage. Although endothelial dysfunction and increased vascular permeability both have a role in the development of MAU, its ethiopathogenesis in hypertensive patients is not yet clearly understood. Vascular endothelial growth factor (VEGF) is the most important regulator of pathological or physiological angiogenesis and it additionally leads to increased vascular permeability. This study aims to assess the relationship of serum VEGF levels to MAU in non-complicated, newly-diagnosed essential hypertensive patients (EHs).
    Methods This study included 30 newly-diagnosed EHs with MAU, 46 newly-diagnosed EHs without MAU and 46 healthy controls. None of the EHs had diabetes, renal impairment or atherosclerotic diseases. Serum VEGF levels were measured using the ELISA method.
    Results Serum levels of VEGF were significantly higher in EHs with MAU when compared with patients without MAU (225.15±109.34 pg/mL versus 166.78±114.35 pg/mL, p: 0.04) or controls (225.15±109.34 pg/mL versus 144.91±96.60 pg/mL, p: 0.007). On the other hand, no significant difference was observed between the non-MAU and control groups. In the univariate analysis, serum levels of VEGF, were positively correlated with systolic blood pressure (R: 0.253 p: 0.001), diastolic blood pressure (R: 0.162 p: 0.04), mean arterial pressure (R: 0.239 p: 0.002), creatinine clearance (R: 0.172 p: 0.04) and MAU (R: 0.338 p: 0.002). In the multiple linear regression analysis, VEGF levels were independently related to MAU (β: 0.248, p: 0.02).
    Conclusion VEGF levels are higher in EHs in the presence of MAU. These high values may be important in the early diagnosis of vascular damage in EHs. Additionally, VEGF may increase glomerular permeability and lead to MAU in EHs.
  • Ko-ichi Tazawa, Masayuki Matsuda, Takuhiro Yoshida, Takahisa Gono, Nag ...
    2008 年 47 巻 17 号 p. 1517-1522
    発行日: 2008年
    公開日: 2008/09/01
    ジャーナル オープンアクセス
    Objective Intensive chemotherapy targeting plasma cell dyscrasia has been recently employed for the treatment of primary systemic AL amyloidosis. We prospectively studied the clinical usefulness of cyclic VAD (vincristine, doxorubicin and dexamethasone) in patients with primary systemic AL amyloidosis who were ineligible for high-dose melphalan with autologous stem cell support.
    Patients and Methods Eight patients (mean age, 60.4±8.8 years) were treated with cyclic VAD until the disappearance of M-protein from both serum and urine. Of these, seven showed nephrotic syndrome before the start of VAD irrespective of a decrease in creatinine clearance. Serial follow-up studies after VAD evaluated hematological status and organ function.
    Results Four patients (50%) showed a marked decrease in abnormal plasma cells in the bone marrow and normalized κ/λ ratios of serum free light chain in conjunction with disappearance of M-protein after 1 to 3 courses of VAD. There were no serious adverse events, and nephrotic syndrome gradually improved with no hematological relapse in the follow-up period of 3 to 5 years. The remaining 4 patients showed worsening of congestive heart failure and/or systemic edema ascribable to dexamethasone, resulting in cessation of cyclic VAD before disappearance of M-protein. All of these patients died of multiple organ failure or required permanent hemodialysis within 1 year after the start of cyclic VAD.
    Conclusion Cyclic VAD is a potent therapeutic option in primary systemic AL amyloidosis, but in patients with renal or cardiac dysfunction careful management for adverse events, especially body fluid retention, is necessary.
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