Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
Volume 49 , Issue 10
Showing 1-14 articles out of 14 articles from the selected issue
REVIEW ARTICLE
  • Toshiyuki Nagasawa, Mitsuhiko Noda, Sayaka Katagiri, Maki Takaichi, Yo ...
    2010 Volume 49 Issue 10 Pages 881-885
    Published: 2010
    Released: May 14, 2010
    JOURNALS OPEN ACCESS
    Periodontitis is regarded to have a close relationship to diabetes mellitus. In Japan, some cohort studies have indicated that there is a significant positive association of obesity plus metabolic syndrome with periodontal diseases. As such, an increasing number of studies suggest a relationship between periodontitis and diabetes, most of which are epidemiologic association. In this review, we have summarized the possible evidence of a relationship between periodontitis and diabetes. To date, little evidence has been reported to indicate that diabetes and/or glucose intolerance has in fact had a significant cause-effect relationship with periodontal disease. In this regard, it is important to directly uncover the relation, i.e., to prove the effect of therapeutic approaches to periodontitis upon mitigation of glycemic control in diabetic patients, which would be a direct evidence of its causal nature. Therefore a study should be undertaken to this effect.
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ORIGINAL ARTICLES
  • Kinya Okamoto, Chihiro Ishida, Yuichiro Ikebuchi, Mari Mandai, Kenichi ...
    2010 Volume 49 Issue 10 Pages 887-895
    Published: 2010
    Released: May 14, 2010
    JOURNALS OPEN ACCESS
    Background and Aim Cytokines and matrix metalloproteinases (MMPs) are involved in tumor growth, invasion, and remote metastasis in various cancers. Recently, functional gene polymorphisms in these cytokines and MMPs have been found, and some reports have revealed an association between these polymorphisms and the prognosis of various cancers. In this study, we examined the relationship between the gene polymorphisms of interleukin 1 beta (IL-1b), IL-1 receptor antagonist (IL-1 RN), transforming growth factor beta 1 (TGF-b1), MMP-1, MMP-3, and MMP-9 and the prognosis of hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC).
    Methods We enrolled 92 HCV-related HCC patients in the study, and gene polymorphisms of IL-1b -31 C/T, IL-1 RN variable number of tandem repeats (VNTR), TGF-b1 +869 C/T, MMP-1 -1,607 1G/2G, MMP-3 -1,171 5A/6A, and MMP-9 -1,562 C/T were analyzed.
    Results In HCC clinical features, TGF-b1 C carriers and MMP-3 5A carriers had significantly larger HCC diameters than TGF-b1 T and MMP-3 6A homozygotes. In HCC prognosis, IL-1b T homozygotes and MMP-3 5A carriers had a significantly poorer prognosis than IL-1b C carriers and MMP-3 6A homozygotes. Those with a combination of IL-1b T homozygosity and MMP-3 5A had synergistically poorer HCC prognosis.
    Conclusion The IL-1b -31 T allele and MMP-3 5A allele are cooperative risk factors for poor prognosis in HCC patients, suggesting that these gene polymorphisms might be potential markers for predicting the prognosis of HCC patients.
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  • Yasuo Kuroki, Hiroshi Kaji, Seiji Kawano, Fumio Kanda, Yutaka Takai, M ...
    2010 Volume 49 Issue 10 Pages 897-902
    Published: 2010
    Released: May 14, 2010
    JOURNALS OPEN ACCESS
    Objective Glucocorticoid (GC) causes various metabolic abnormalities; however, few prospective studies have examined the changes in glucose and lipid metabolism in newly GC-treated patients.
    Methods and Patients The present study was therefore performed to analyze markers of glucose and lipid metabolism on days 0, 3, 7, 14, 28 and at month 3 of treatment in patients starting GC therapy. Then, we analyzed the relationships between the changes in these parameters and the initial dose of prednisolone (PSL), separating groups into different regimens by the GC dose.
    Results The fasting plasma glucose (FPG) level transiently increased on day 3 of PSL administration but was restored by day 7. The immunoreactive insulin (IRI) level and HOMA-R transiently increased on day 3 and then fell, although remaining significantly higher than each basal level by day 7. A transient elevation in FPG level on day 3 was observed only in groups with a PSL dose ≥40 mg. On the other hand, total cholesterol and low-density lipoprotein cholesterol levels increased on day 3 of PSL administration and similar levels were maintained after day 7. High density-lipoprotein cholesterol levels were significantly increased on day 3; subsequently then gradually increased from days 3 to day 28. Triglyceride levels did not change during treatment. No relationship was apparent between the GC dose and the changes in each lipid parameter.
    Conclusion GC treatment induced changes in FPG, IRI, LDL-CHOL and HDL-CHOL levels from day 3 after start of GC. The dose of GC seemed to influence glucose metabolism, but not lipid metabolism.
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CASE REPORTS
  • Giuseppina Novo, Giovanni Ferro, Giovanni Fazio, Giuseppe Coppola, Gia ...
    2010 Volume 49 Issue 10 Pages 903-905
    Published: 2010
    Released: May 14, 2010
    JOURNALS OPEN ACCESS
    Takotsubo cardiomyopaty is a recently described syndrome characterized by transient left ventricular dysfunction, mimicking an acute coronary syndrome and usually precipitated by a physical or emotional stress. We report the first case of Takotsubo cardiomyopathy after acute diarrhea in a man. It may be argued that severe diarrhea in predisposed individuals may cause an acute stress resulting in increased sympathetic activity leading to this syndrome. Probably the relationship between the adrenergic system and the heart is more complex than general thought and the stimuli which favor an autonomic imbalance and precipitate the syndrome are very disparate in clinical practice.
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  • Shusuke Yagi, Masashi Akaike, Mitsunori Fujimura, Takehiko Kimura, Tak ...
    2010 Volume 49 Issue 10 Pages 907-912
    Published: 2010
    Released: May 14, 2010
    JOURNALS OPEN ACCESS
    Congenital ventricular diverticulum (CVD) in adults is a rare cardiac malformation, which includes fibrous type congenital ventricular aneurysm (CVA). CVA is often clinically asymptomatic and shows no abnormality in the electrocardiogram or chest X-ray. However, some cases of sudden death resulting from ventricular tachycardia, cardiac embolism or ventricular rupture have been reported. Therefore, physicians should perform further cardiac imaging studies to detect a CVA if ventricular arrhythmia originating from the left ventricle is observed. Here, we report two successfully followed cases of CVA which were diagnosed from premature ventricular contractions.
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  • Hidenobu Okuyama, Osamu Hirono, Daisuke Ishigaki, Koichi Yuki, Isao Ku ...
    2010 Volume 49 Issue 10 Pages 913-918
    Published: 2010
    Released: May 14, 2010
    JOURNALS OPEN ACCESS
    A 59-year-old man visited our hospital due to right leg edema and right leg pain. Computed tomography revealed that the circumferential enhancement of bilateral external iliac arteries by soft tissue that had similar density as the adjacent psoas muscle and that the right external iliac vein that was constricted by those tissues. The patient was diagnosed as retroperitoneal fibrosis. He underwent stent implantation to the right external iliac vein stenosis and steroid therapy. His right leg edema and pain was immediately improved after the stent implantation and he achieved remission.
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  • Kohei Yamaguchi, Etsuro Tsutsumi
    2010 Volume 49 Issue 10 Pages 919-923
    Published: 2010
    Released: May 14, 2010
    JOURNALS OPEN ACCESS
    A male patient was diagnosed with diabetes mellitus at age 37 and insulin treatment was introduced at age 49. About 2 years after the introduction of insulin, the antihypertensive agent was switched from candesartan (4 mg/day) to telmisartan (20 mg/day). The alteration improved his glycemic control dramatically, with the HbA1c levels decreasing from 8.3% to 6.0% in 6 months. Gradual marked reduction in insulin requirement was observed as it was reduced from 62 U/day to 46 U/day in 6 months and to 18 U/day in 15 months. Also his body weight was reduced from 81 kg to 65 kg in 15 months without remarkable life-style modification. Throughout the whole clinical course mentioned above, he was under treatment for schizophrenia with drugs including risperidone which possibly affects glucose metabolism. The medication for schizophrenia was not changed during this period. We present here the marked glycemia improvement effect and insulin sparing effect of telmisartan in a case of type 2 diabetes mellitus.
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  • Hideki Shibuya, Hiroko Sano, Kou Osamura, Kosei Kujime, Kei Hara, Tets ...
    2010 Volume 49 Issue 10 Pages 925-929
    Published: 2010
    Released: May 14, 2010
    JOURNALS OPEN ACCESS
    A 68-year-old man, who had worked for processing quartz-containing stones for more than 50 years, complained of low-grade fever and arthralgia. Mediastinal lymph nodes were markedly swollen on chest computed tomography. Pathological findings of the lymph node were compatible with silicosis, with a high titer of myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA). During follow-up with prednisolone treatment, pleuritis and uveitis developed as manifestations of vasculitis. Thus, he was diagnosed with MPO-ANCA-associated vasculitis with occupational silica exposure, possibly microscopic polyangiitis (MPA). This case is rare, because pleuritis was the only pulmonary manifestation, without interstitial pneumonia, alveolar hemorrhage or glomerulonephritis.
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  • Shihoko Wakabayashi, Kazuteru Ohashi, Ryo Hanajiri, Takeshi Kobayashi, ...
    2010 Volume 49 Issue 10 Pages 931-935
    Published: 2010
    Released: May 14, 2010
    JOURNALS OPEN ACCESS
    We report a case of Epstein-Barr virus (EBV)-associated lymphoproliferative disease (LPD) following unrelated bone marrow transplantation (UBMT) for severe aplastic anemia treated with a conditioning regimen that included anti-thymocyte globulin (ATG). The patient showed signs of EBV reactivation as early as 34 days after UBMT. Our weekly schedule for EBV monitoring failed to trace rapid changes in EBV viral load and the patient eventually developed EBV-LPD. However, early intervention with monoclonal antibody against CD20, rituximab, stopped the further progression of EBV-LPD. As several recent reports have suggested, the safety and efficacy of rituximab treatment for EBV-LPD is supported by our limited experience with post transplant EBV-LPD.
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  • Yasuhiro Shimojima, Wataru Ishii, Masayuki Matsuda, Hideyuki Nakazawa, ...
    2010 Volume 49 Issue 10 Pages 937-940
    Published: 2010
    Released: May 14, 2010
    JOURNALS OPEN ACCESS
    We report a patient with rheumatoid arthritis (RA) who developed cytomegalovirus (CMV)-induced infectious mononucleosis-like syndrome (IMLS) while being treated with methotrexate and infliximab. She suddenly developed intermittent high fever and general fatigue with liver dysfunction, remarkable lymphocytosis and laboratory data suggestive of CMV reactivation. Her clinical symptoms quickly improved after the cessation of methotrexate and infliximab without the use of anti-viral drugs such as ganciclovir. CMV-induced IMLS might be a cause of persistent fever in RA patients, particularly when biologics are used for treatment.
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  • Kayoko Ishihara-Kawase, Toshiho Ohtsuki, Sayaka Sugihara, Hitomi Tanak ...
    2010 Volume 49 Issue 10 Pages 941-943
    Published: 2010
    Released: May 14, 2010
    JOURNALS OPEN ACCESS
    Paroxysmal nocturnal hemoglobinuria is a rare acquired disorder of clonal hematopoietic stem cells and it is characterized as a hypercoagulable disorder. We report a 36-year-old woman with the rare triad of paroxysmal nocturnal hemoglobinuria, cerebral sinus thrombosis triggered by infection, and rapid-onset heparin-induced thrombocytopenia after resensitization of heparin. This case raises caution for heparin-induced thrombocytopenia in paroxysmal nocturnal hemoglobinuria.
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  • Yuichiro Inatomi, Toshiro Yonehara, Teruyuki Hirano, Makoto Uchino
    2010 Volume 49 Issue 10 Pages 945-948
    Published: 2010
    Released: May 14, 2010
    JOURNALS OPEN ACCESS
    We present a 70-year-old man who suffered two attacks of possible incomplete infarction. At the first attack, the responsible lesion was unclear on MRI including DWI, but demonstrated a high uptake of 99mTc-ECD SPECT during the acute phase; thereafter the lesion became atrophic with a low uptake on SPECT during the chronic phase. At the second attack, the responsible lesion revealed weakly hyperintense changes on DWI without marked changes on conventional modalities, but had a high uptake on SPECT and capillary blush on angiography during the acute phase. It is suggested that incomplete infarction can solely result in a massive and clinically critical lesion without an accompanying complete infarction.
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  • Masashi Matsuyama, Yukiko Miura, Takumi Kiwamoto, Ataru Moriya, Nariak ...
    2010 Volume 49 Issue 10 Pages 949-953
    Published: 2010
    Released: May 14, 2010
    JOURNALS OPEN ACCESS
    We report one Japanese familial line in which there were three pulmonary MAC patients and one suspected patient over two generations, most of whom were diagnosed with the nodular/bronchiectatic type. In all patients, life circumstances and bacterial strains differed at the time of diagnosis. This suggests that the genes thought to affect patient susceptibility to pulmonary MAC disease may be involved in this family line. Comprehensive genotypic analysis of the CFTR gene, HLA typing, and analysis of the NRAMP1 polymorphisms were performed in seven members of this family. The results suggest that female sex and menopause might be associated with onset of pulmonary MAC of the nodular/bronchiectatic type, and HLA-A26 antigen and diabetes mellitus might be involved in disease exacerbations.
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