Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
47 巻, 20 号
選択された号の論文の12件中1~12を表示しています
ORIGINAL ARTICLES
  • Teng-Yu Lee, Han-Chung Lien, Chi-Sen Chang, Mei-Chin Wen
    2008 年 47 巻 20 号 p. 1767-1773
    発行日: 2008年
    公開日: 2008/10/15
    ジャーナル オープンアクセス
    Objective The pathophysiological data on Barrett's esophagus are scant in Asia, so the purpose of this study was to compare and analyze the pathophysiological characteristics of Barrett's esophagus and reflux esophagitis among Chinese in Taiwan.
    Patients and Methods From November 2001 to January 2003, fifteen patients with Barrett's esophagus were consecutively enrolled as the Barrett's esophagus group. Fourteen patients with Los Angeles grade A/B esophagitis (mild esophagitis group) and fourteen patients with LA grade C/D esophagitis (severe esophagitis group) who were matched in age and gender with the Barrett's esophagus group were enrolled. The data of esophageal manometry and ambulatory 24-hour pH monitoring were collected.
    Results We found that the Barrett's esophagus group had significantly weaker lower esophageal sphincter (LES) pressure and distal esophageal body contractions (p<0.05) than the mild esophagitis group. Both the Barrett's esophagus group and severe esophagitis group had significantly higher esophageal acid reflux scores and frequency (p<0.05-0.01) compared to the mild esophagitis group. However, data on esophageal manometry and 24-hour pH monitoring in the Barrett's esophagus and severe esophagitis groups did not significantly differ.
    Conclusion We concluded that Barrett's esophagus had significantly stronger acid reflux, lower LES pressure, and weaker distal esophageal peristalsis compared to mild esophagitis. Barrett's esophagus and severe reflux esophagitis share common pathophysiological characteristics among Chinese in Taiwan.
  • Atsushi Hoshino, Takashi Nakamura, Satoko Enomoto, Hiroyuki Kawahito, ...
    2008 年 47 巻 20 号 p. 1775-1781
    発行日: 2008年
    公開日: 2008/10/15
    ジャーナル オープンアクセス
    Objective We have recently reported the prevalence of subclinical cardiovascular diseases and the association between the presence of subclinical coronary artery disease (CAD) and vascular risk factors in ischemic stroke patients. The relationship between the presence of subclinical CAD and elements of brain ischemia including intracranial artery stenosis, silent brain infarction (SBI), and white matter lesions remains unclear. We determined the usefulness of elements of brain ischemia to predict the presence of subclinical CAD in ischemic stroke patients.
    Methods The study group comprised 100 patients with first-ever ischemic stroke who had no history of CAD. Intracranial artery stenosis on magnetic resonance angiography and SBI and white matter lesions on magnetic resonance imaging were investigated in comparison with CAD defined as ≥50% stenosis on coronary computed tomographic angiography.
    Results Thirty-six patients had subclinical CAD. Intracranial artery stenosis (78.1% vs 35.1%, p<0.0001) and SBI (69.4% vs 46.9%, p=0.03) were more prevalent in patients with subclinical CAD. Of the patients with both intracranial artery stenosis and SBI, 61% had subclinical CAD. Multiple regression analyses showed that the presence of subclinical CAD was independently associated with intracranial artery stenosis; <50% stenosis (OR 8.01 95%CI 2.02 to 31.9; p<0.01), ≥50% stenosis (OR 19.5 95%CI 2.77 to 137.4; p<0.01), and multiple SBI (OR 3.85 95%CI 1.23 to 12.0; p<0.05).
    Conclusion The evaluation of intracranial artery stenosis and SBI may be useful to identify ischemic stroke patients at high risk for subclinical CAD.
  • Takuhiro Yoshida, Masayuki Matsuda, Nagaaki Katoh, Ko-ichi Tazawa, Yas ...
    2008 年 47 巻 20 号 p. 1783-1790
    発行日: 2008年
    公開日: 2008/10/15
    ジャーナル オープンアクセス
    Objective Primary systemic AL amyloidosis arises from immunoglobulin light chains produced by plasma cell dyscrasia. To prospectively investigate the production of M-protein and plasma cells in bone marrow before and after chemotherapy, we performed flow cytometry and analysis of serum free light chains (FLCs).
    Patients and Methods Fifty-nine patients with primary systemic AL amyloidosis (mean age, 59.9±8.8 years) were enrolled in this study, and of these 31 were serially studied before and after chemotherapy. Complete hematological remission was defined as normalization of the FLC κ/λ ratio.
    Results MPC-1-CD45- (p<0.05) and MPC-1+CD45-CD49e- (p<0.005) were significantly higher, and MPC-1--CD45+ (p<0.05), MPC-1+CD45+CD49e- (p<0.0001) and MPC-1+CD45+CD49e+ (p<0.0005) were significantly lower in the patients with AL amyloidosis than in controls. There was a significantly positive correlation between the serum predominant FLC/serum creatinine ratio and MPC-1+CD45-CD49e- (p<0.05). After chemotherapies, such as high-dose melphalan with autologous stem cell support, 20 of 31 patients with AL amyloidosis achieved complete hematological remission. There were no significant differences in any subtype of plasma cells before treatment between the remission and non-remission groups, but in the former group MPC-1+CD45-CD49e- and MPC-1-CD45+ were significantly decreased and increased after chemotherapy compared with before, respectively.
    Conclusion Abnormal plasma cells in the bone marrow, particularly the MPC-1+CD45-CD49e- subset, may be important as a follow-up marker before and after chemotherapy in primary systemic AL amyloidosis. These cells maintain low levels as long as no relapse occurs.
  • Yuko Komase, Tadashi Abe, Keita Kasahara, Takeshi Kaneko, Hiroshi Taka ...
    2008 年 47 巻 20 号 p. 1791-1796
    発行日: 2008年
    公開日: 2008/10/15
    ジャーナル オープンアクセス
    Objective Since mild COPD can be detected in the annual health check by lung function tests, we conducted a questionnaire survey on how such examinations are used to assess chronic obstructive pulmonary disease (COPD).
    Methods We mailed questionnaires to 633 facilities performing comprehensive medical check-up from June to July 2005 and obtained responses from 254 (40.1%).
    Results At participating facilities, the proportion of full or part-time physicians specializing in respiratory diseases was low [40 of 366 full timers (10.9%) and 114 of 2,044 part-timers (5.6%)], with very few physicians certified by the Japanese Respiratory Society (6.8%). Non respiratory physicians were involved in evaluating the results of thoracic diagnostic imaging at 32 facilities. Lung function tests were carried out at 98.2% of facilities though relatively few facilities evaluated test results with COPD in mind. All stages (mild, moderate, severe) of COPD were diagnosed in patients at 85 facilities (39.2%), while only severe COPD was targeted by chest imaging at 97 facilities (44.7%), disregarding mild and moderate cases. Counseling for smoking cessation was provided at 113 facilities (20.6%), while 30 facilities (14.4%) provided no form of smoking cessation.
    Conclusion At most facilities performing a comprehensive medical check-up, there was not a sufficient number of respirologists to ensure early diagnosis of COPD and this may have compromised COPD diagnosis. The newly proposed Japan Society of Comprehensive Medical Check-up (Ningen-dock) Standards based on the Japanese Respiratory Society may be useful to reveal early stages of COPD.
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