Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
47 巻, 4 号
選択された号の論文の30件中1~30を表示しています
ORIGINAL ARTICLES
  • Norimitsu Uza, Hiroshi Nakase, Satoru Ueno, Satoko Inoue, Sakae Mikami ...
    2008 年 47 巻 4 号 p. 193-199
    発行日: 2008年
    公開日: 2008/02/15
    ジャーナル オープンアクセス
    Background Fistulas are a major complication of Crohn's disease (CD), but the treatment strategy for fistulizing Crohn's disease is controversial. The aim of this study is to analyze the efficacy of medical therapy for fistulizing Crohn's disease.
    Methods Therapeutic regimens and clinical outcome of medical therapy were evaluated in 10 patients with fistulizing Crohn's disease (6 with external fistulas, 4 with internal fistulas). Complete response was defined as fistula closure with complete arrest of drainage in cases of external fistula, and disappearance of the fistula demonstrated by imaging studies in cases of internal fistula. Clinical remission was defined as a Crohn's disease activity index of less than 150 points.
    Results Complete responses were observed in all 6 patients with external fistulas (4 patients treated with a combination of antibiotics and immunomodulators, and 2 also treated with infliximab). In contrast, fistula closure was observed in only 1 of 4 patients with internal fistulas. Clinical remission of CD was achieved in all patients with external fistulas, whereas there was no significant difference in the CD activity index before and after medical therapy in patients with internal fistulas.
    Conclusions External fistulas were more responsive to medical therapy than internal fistulas in patients with CD. Combined treatment with antibiotics and immunomodulators might be a suitable initial therapy for CD patients with external fistulas, and infliximab can be used as an additional therapy in cases refractory to this combination therapy. However, randomized controlled studies will be required to investigate what kinds of therapies are optimal for CD patients with fistulas.
  • Nobuo Shiode, Kinya Shirota, Kenji Goto, Akinori Sairaku, Shinya Mikam ...
    2008 年 47 巻 4 号 p. 201-204
    発行日: 2008年
    公開日: 2008/02/15
    ジャーナル オープンアクセス
    Background The sirolimus-eluting stent (SES) has dramatically reduced the rate of restenosis in comparison to that with the bare-metal stent (BMS). In previous studies, the minimal luminal diameter (MLD) of lesions treated with a BMS was shown to improve from 6 months to 1 year.
    Methods To evaluate 6-month and 1-year outcomes, angiographic follow-up data were analyzed for 285 patients (451 lesions) who underwent successful SES implantation compared to follow-up data for 2,561 patients (3,367 lesions) who underwent BMS implantation.
    Results Angiographic follow-up was performed at 6 months for 396 SES-treated lesions and 2,628 BMS-treated lesions and at 1 year for 322 SES-treated lesions and 1,540 BMS-treated lesions. The 6-month angiographic restenosis rate was significantly lower for SES-treated lesions than for BMS-treated lesions (4.8% vs. 23.4%, p<0.01). From immediately after stent implantation to 6 months, quantitative coronary angiography revealed a significantly larger decrease in MLD of BMS-treated lesions than in MLD of SES-treated lesions (p<0.01). In BMS-treated lesions in which repeat revascularization was not performed at 6 months, MLD increased significantly from 2.08±0.63 mm at 6 months to 2.11±0.61 mm at 1 year (p<0.01). In SES-treated lesions, however, MLD decreased significantly from 2.55±0.56 mm at 6 months to 2.44±0.61 mm at 1 year (p<0.05).
    Conclusions From 6 months to 1 year, stenosis of BMS-treated lesions regressed, but stenosis of SES-treated lesions progressed.
  • Serdal Ugurlu, Erkan Caglar, Tijen Erdem Yesim, Eda Tanrikulu, Gunay C ...
    2008 年 47 巻 4 号 p. 205-209
    発行日: 2008年
    公開日: 2008/02/15
    ジャーナル オープンアクセス
    Objective To determine the characteristics of thyroid nodules by using fine needle aspiration (FNA) biopsy and ultrasonography.
    Patients and Methods FNAs of 1,004 patients with thyroid nodules between 2000 and 2007 were evaluated retrospectively. The surgical records of 101 of the patients were available and reviewed. The Odds ratios for nodule characteristics were calculated individually.
    Results The sensitivity of FNA was 66.7% and the specifity was 95.2%. Positive predictive value was 72.7% and negative predictive value was 93.7%. Our diagnostic accuracy was 90.5%. Solitary nodules, irregular margins and microcalcifications were associated with increased risk of malignancy with Odds ratios 3.61 (95% CI: 1.25-10.42; p= 0,017); 5.44 (95% CI: 1.76-16.78; p= 0,003) and 39.29 (95% CI 8.32-185.47; p< 0.001) respectively. Macrocalcification, age, gender and thyroid status were not associated with increased risk of malignancy.
    Conclusion Our data suggest that FNA is a reliable, reproducible and valid method to evaluate thyroid nodules and ultrasonographic features, especially microcalcification is a very important predictor of malignancy.
  • Seyhan EkremCengiz, Erdogan Cetinkaya, Sedat Altin, Zeki Gunluoglu, Ad ...
    2008 年 47 巻 4 号 p. 211-216
    発行日: 2008年
    公開日: 2008/02/15
    ジャーナル オープンアクセス
    Objectives Our study aimed to determine the frequency of sick euthyroid syndrome (SES) among patients diagnosed as non-small cell lung cancer (NSCLC) and its association with the stage of the disease, Karnofsky index (KI), and nutritional parameters.
    Methods We enrolled 80 consecutive patients with newly diagnosed NSCLC. Cases with NSCLC were staged by using the TNM system. The cases were examined for thyroid function tests, KI and nutritional evaluation before treatment. Moreover, cases were investigated for their overall survival ratio.
    Results Out of 80 patients, SES was identified in 28 (35%). SES was more frequent among stage III (26%) and stage IV (62%) cases. The body mass index (BMI), KI and serum albumin level were found to be significantly low in cases with SES when compared to cases without SES. SES was found to be negatively correlated with BMI, KI and serum albumin level, and it was positively correlated with disease stage and weight loss. Additionally, the presence of SES was found as a prognostic factor at survival analysis (p=0.0002).
    Conclusion SES was frequently seen in cases with NSCLC. SES can be used as a predictor of poor prognosis in NSCLC patients.
  • Yoshiaki Minakata, Hideya Iijima, Tsuneyuki Takahashi, Motohiko Miura, ...
    2008 年 47 巻 4 号 p. 217-223
    発行日: 2008年
    公開日: 2008/02/15
    ジャーナル オープンアクセス
    Objective This study evaluated the efficacy and safety of the formoterol Turbuhaler® at dosages of 4.5, 9 and 18 μg bid compared with placebo in Japanese patients with COPD.
    Methods In this randomized, double-blind, placebo-controlled, multicenter study, 36 patients with a pre-bronchodilator FEV1 value within 40 to 70% of the predicted value were randomized to receive formoterol at doses of 4.5, 9, and 18 μg bid, and placebo, for 1 week in a crossover fashion.
    Results The primary outcome variable, one hour post-dose FEV1 on the last day of the one week treatment period, was significantly higher for all formoterol dosages compared with placebo (p<0.001 for all doses); adjusted g-means for formoterol 4.5, 9 and 18 μg bid, and placebo, were 1.510 L, 1.491 L, 1.520 L and 1.342 L, respectively. All three dosages of formoterol also provided significantly better improvements than placebo in the secondary variables FVC, inspiratory capacity (IC) and morning and evening PEF. Results for IC and PEF indicated a trend towards a larger improvement at higher dosages.
    Conclusion Treatment with formoterol at dosages of 4.5, 9 and 18 μg bid showed significantly superior effects to placebo on FEV1 in Japanese patients with COPD. The results for some of the secondary variables (IC and PEF) indicated a trend towards larger improvements at higher dosages. All dosages of formoterol were well tolerated in Japanese patients.
  • Yoshiaki Kaji, Koichi Hirata
    2008 年 47 巻 4 号 p. 225-229
    発行日: 2008年
    公開日: 2008/02/15
    ジャーナル オープンアクセス
    Background Post-stroke depression (PSD) has a great impact on the quality of life of patients with stroke. The Mini International Neuropsychiatric Interview (MINI) and the Hamilton Depression Scale (HAM-D17) are considered the most reliable diagnostic tests for depression. However, both are difficult to conduct in a clinical setting since they require completion of a questionnaire in a limited time period. The Japan Stroke Scale -Depression Scale- (JSS-D) was established by the Japan Stroke Society to evaluate mood disorders following stroke, including PSD. Here, we correlated the results of HAM-D17, MINI and JSS-D scores.
    Methods We studied 100 stroke patients (mean age: 64.6±11.6 [±SD], range: 32-85 years) in the subacute phase (2-5 weeks after onset). We determined the correlations between HAM-D17 and JSS-D scores. We used MINI to diagnose PSD, which represented major and minor depression, and compared the results with those of JSS-D.
    Results JSS-D scores correlated with those of HAM-D17 (r=0.847, p <0.0001). The cutoff value of JSS-D score for PSD was 2.40. The sensitivity and specificity were 0.950 and 0.988, respectively.
    Conclusion JSS-D is the most valuable diagnostic test for PSD based on its ease of use and reliability for estimating PSD in Japan.
  • Koichi Okamoto, Tsuneo Yamazaki, Haruhiko Banno, Gen Sobue, Mari Yoshi ...
    2008 年 47 巻 4 号 p. 231-236
    発行日: 2008年
    公開日: 2008/02/15
    ジャーナル オープンアクセス
    Objective This study was to clarify the neuropathological findings of non-herpetic acute limbic encephalitis (NHALE) and so-called acute juvenile female non-herpetic encephalitis (AJFNHE).
    Methods We examined three rare autopsied cases consisting of probable one NHALE and two AJFNHLE. For comparison, we also studied 10 autopsied cases of hippocampal sclerosis mainly caused by anoxia.
    Results In NHALE, neuronal loss with gliosis and microglia/macrophage infiltrations were mainly seen in the CA1 areas in the hippocampus. However, there were no apparent anoxic neuronal changes in the remaining neurons in the CA1, and astrocyte proliferations and microglia/macrophage infiltrations were also observed in the claustrum, while these were mildly present in the basal ganglia. In AJFNHE, pathological findings differed from those of NHALE with regard of the absence of limited pathology in the limbic system, microglia/macrophages widely infiltrated the brain including the hippocampal areas and mild lymphocytic infiltrations were observed in the subarachnoid spaces as well as in the parenchyma.
    Conclusions The pathomechanism of NHALE and AJFNHE is obscure and autoimmune theory is proposed, however we must collect and examine many autopsied cases in order to clarify the pathomechanism.
  • Yoshihiro Kobashi, Keiji Mouri, Shinichi Yagi, Yasushi Obase, Minoru F ...
    2008 年 47 巻 4 号 p. 237-243
    発行日: 2008年
    公開日: 2008/02/15
    ジャーナル オープンアクセス
    Objective We prospectively evaluated the usefulness of the QuantiFERON TB-2G (QFT-2G) compared to that of tuberculin skin test (TST) as a supportive method of diagnosing pulmonary tuberculosis (TB) without invasive examinations.
    Methods The subjects were 90 patients who required differentiation of pulmonary TB clinically and for whom a definitive diagnosis could not be obtained after admission. The final clinical diagnosis of TB infection in 28 patients and non-TB infection in 62 patients was established using bronchoscopic procedures.
    Results In patients with TB infection, the positive response rate on QFT-2G (79%) was significantly higher than that on TST (57%). The QFT-2G negative rate (5%) was significantly lower than that on TST (48%) in patients with non-TB infection. For QFT-2G test, there was a positive response in 25 patients, a negative response in 49, and indeterminate findings in 16. Of the two patients with a false-negative result on QFT-2G, one had pulmonary TB during immunosuppressive treatment and one had pulmonary tuberculoma. Of the three non-TB patients with a positive result on QFT-2G, two had pneumonia and one had pulmonary mycosis. Four TB patients with an indeterminate result on QFT-2G included two elderly patients and two immunocompromised patients.
    Conclusions We could confirm the usefulness of the QFT-2G test compared to TST in patients requiring a differential diagnosis between pulmonary TB and other pulmonary diseases in this series. Therefore, we recommend the QFT-2G test as one of the useful noninvasive diagnostic examinations for pulmonary TB.
  • Akira Watanabe, Katsunori Yanagihara, Shigeru Kohno, Toshiharu Matsush ...
    2008 年 47 巻 4 号 p. 245-254
    発行日: 2008年
    公開日: 2008/02/15
    ジャーナル オープンアクセス
    Objective The aim of this study was to investigate the pathophysiology of hospital-acquired pneumonia (HAP) and the clinical efficacy of its first-line treatment and to examine the validity of "the Japanese Respiratory Society (JRS) Guidelines for management of HAP".
    Methodology The observational survey was conducted during the period of June 2002-May 2004 and patients with HAP were prospectively surveyed using the consecutive enrollment method. A total of 1,356 patients from 254 hospitals nationwide were analyzed. Clinical response to first-line antibiotics was evaluated at the end of the medication.
    Results The 30-day mortality rate was 19.8%. Patients were classified into four groups according to the JRS guideline criteria. There were remarkable variances in the number of cases of each group. Mild/moderate pneumonia with no risk factors (group I) accounted for 0.3% of all cases. The mortality rate tended to be higher, as clinical conditions became more serious (group II < III < IV). Alternatively, though categorized in the same group (group III), there was a difference in the mortality rate by the severity of pneumonia (severe cases 32.2% vs. moderate cases 11.0%). First-line medication using carbapenems accounted for 61.7% of total cases. The efficacy rate of guideline-concordant therapy was significantly higher than that of guideline-discordant therapy (54.2% vs. 41.7%).
    Conclusions This is the first nationwide study on HAP in Japan. The clinical characteristics and prognosis of HAP were elucidated. Review of the current classification of the disease is required and these results provide valuable information for the next revision of the guidelines.
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