Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
Volume 50, Issue 1
Displaying 1-12 of 12 articles from this issue
  • Hiromi Ishibashi, Atsumasa Komori, Shinji Shimoda, Yoko M. Ambrosini, ...
    2011 Volume 50 Issue 1 Pages 1-10
    Published: 2011
    Released on J-STAGE: January 01, 2011
    The natural history of the disease varies greatly among individual patients with primary biliary cirrhosis (PBC). Some patients live long without any symptoms while other patients present jaundice and develop hepatic failure in early phases of the disease. Previous studies showed that the natural course of PBC is altered by the use of ursodeoxy cholic acid (UDCA). In this review we discuss variation in the natural course of the disease and it's alteration by UDCA, and risk factors that predict disease progression. Based on clinical observations, there are three types of clinical evolution in PBC: 1) minimal to slow progression over several years; 2) rapid progression to jaundice and hepatic failure, and 3) progression to portal hypertension without developing deep jaundice. Notably, based on our analyses accelerated progression to jaundice and liver failure are reflected by a sustained serologic presence of anti-gp210 antibodies whereas patients with portal hypertension in the absence of jaundice have anti-centromere autoantibodies. These observations highlight the clinical importance of antinuclear antibody analysis in patients with PBC.
    Download PDF (192K)
  • Atsushi Yoshida, Kenji Kobayashi, Fumiaki Ueno, Eiki Yoshimatsu, Keiji ...
    2011 Volume 50 Issue 1 Pages 11-15
    Published: 2011
    Released on J-STAGE: January 01, 2011
    Background Cytaphresis (CAP) is an effective modality in the treatment of active ulcerative colitis (UC), but the time lag before a notable clinical response on scheduled therapy frequently causes a significant delay in the modification of treatment. We previously reported that the clinical response after CAP was predicted by early application of transabdominal ultrasound (TAUS), but the predictability of long-term outcome after CAP still remains uncertain.
    Methods Patients: Twenty-six patients with active UC who received CAP were followed for 1 year. In addition to CAP they received pharmaceutical regimens, such as corticosteroid, 5-aminosalicylic acid, and immunomodulator, as indicated clinically. The mean UC-DAI score was 9.7 before CAP, and 3.2 at 1 year after CAP. Prognostic factor: Total colonic wall thickness was measured by TAUS at 2 to 3 weeks after the initiation of the treatment, and decrement from baseline was calculated. Early ultrasonographic response (EUR) was defined as a decrement statistically. UC-DAI score of 2 or less at 1 year was defined as sustained clinical remission. Score of 6 or more was defined as clinical relapse.
    Results EUR was defined as a decrement in wall thickness by at least 2.5 mm from the baseline. EUR was noted in 11 patients, and the remaining 15 did not attain EUR. Outcome measures: In the UC-DAI score measured at 1 year after initiation of treatment 90.9% of patients with EUR, whereas 40.0% with non-EUR (p<0.05) showed sustained clinical remission. Regarding relapse, within 1 year 9.1% of patients with EUR relapsed whereas 46.7% with non-EUR (p<0.05) relapsed.
    Conclusion Early application of TAUS may predict the long-term clinical outcome after CAP in patients with active UC.
    Download PDF (479K)
  • Esra Tug, Hatip Aydin, Ebru Kaplan, Dilek Dogruer
    2011 Volume 50 Issue 1 Pages 17-21
    Published: 2011
    Released on J-STAGE: January 01, 2011
    Objective We aimed to determine the prevalences of important genetic causes of thromboembolism for the first time in the western Black Sea Region of Turkey.
    Patients and Methods One hundred and eighty-eight patients diagnosed early with thrombophilia were included in the study. The samples were genotyped using real-time LightCycler.
    Results Of the 188 patients, 179 (95.2%) had one or more mutations. The frequencies of Factor V (FV) Leiden (FVL, G1691A), FV H1299R (A1299G), Factor II (FII G20210A), methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C were 11.7%, 5.6%, 2.5%, 30.4% and 39.1%, respectively. FV1691A was commonly represented in deep venous thrombosis (34.2%). The highest frequencies of FV1299G and FII20210A were in the vascular headache and deep venous thrombosis groups (10% and 10.5%, respectively). MTHFR677T was common in the pulmonary embolism (37%). MTHFR1298C frequency was 55.9% in recurrent abortus. Within-group comparisons yielded significant differences in the distributions of the FVL and FV H1299R mutations (p=0.002 and p=0.039, respectively).
    Conclusion There were significant positive associations between venous thromboembolism and FVL and FV H1299R. FVL mutation in DVT may be an important predisposing factor that needs to be tested routinely in this population.
    Download PDF (122K)
  • Tomonari Okada, Toshiyuki Nakao, Hiroshi Matsumoto, Yume Nagaoka, Ryo ...
    2011 Volume 50 Issue 1 Pages 23-29
    Published: 2011
    Released on J-STAGE: January 01, 2011
    Background Glycated albumin (GA), which is an alternative glycemic marker, is influenced by factors associated with albumin turnover, and it is not clear whether proteinuria influences GA values in diabetic patients with chronic kidney disease (CKD).
    Methods We enrolled 94 diabetic patients with CKD stages 3 to 5. GA, glycated hemoglobin, and urinary protein excretion (UP) levels were consecutively obtained in each patient. The correlations between GA and UP and those between changes in GA and UP were examined.
    Results There was a significant correlation between GA and UP in all cases (r=-0.46, p<0.0001), however no significant correlation was found in cases with UP of 0-3.49 g/day (r=0.01). GA values in cases with UP ≥3.5 g/day were significantly lower than those in cases with UP <3.5 g/day [UP ≥3.5 g/day and serum albumin (Alb) ≤3 g/dL; 12.0 ± 1.3%, UP ≥3.5 g/day and Alb >3 g/dL; 17.8 ± 4.3%, 0≥ UP <3.5 g/day; 21.2 ± 4.2%], while no significant difference in HbA1c or glucose levels was found. In cases with a minimum of UP ≥0.5 g/day, no significant correlation was found between the difference in GA and the difference in UP at the point of maximum UP and minimum UP (r=0.04).
    Conclusion Nephrotic-range proteinuria decreases GA values independent of the glycemic state, while non-nephrotic range proteinuria has no significant influence on GA values in diabetic CKD patients.
    Download PDF (157K)
  • Takuya Fukuoka, Daisuke Furuya, Hidetaka Takeda, Tomohisa Dembo, Harum ...
    2011 Volume 50 Issue 1 Pages 31-35
    Published: 2011
    Released on J-STAGE: January 01, 2011
    Objective Clopidogrel has potent antiplatelet effects, but recent interest has focused on clopidogrel resistance, in which platelet function is not inhibited despite taking the drug. This study evaluated clopidogrel resistance in ischemic stroke patients.
    Methods After taking oral clopidogrel 75 mg/day for ≥1 week, platelet aggregometry was performed by turbidimetry in all patients, and by a screen filtration pressure method using whole blood in 37 patients. Using turbidimetry, resistance was defined as platelet maximum aggregation rate ≥34% with aggregation-inducing agent ADP 1 μmol/L, or ≥66% with ADP 4 μmol/L. Using the screen filtration pressure method, resistance was defined as a minimum concentration of ≤3 μmol/L ADP to induce secondary aggregation of platelets.
    Patients This study was conducted in 72 patients (52 men, 20 women; mean age, 69 ± 8 years; range, 50-84 years) with non-cardiogenic ischemic cerebrovascular disease.
    Results Based on turbidimetry, the rate of clopidogrel resistance was 8.3% with ADP 1 μmol/L and 18.1% with 4 μmol/L. Based on the screen filtration pressure, the rate of clopidogrel resistance was 8.1%. The differences between turbidimetry and screen filtration pressure methods, regarding the measurement of the presence of resistance in the same patient, were observed.
    Conclusion Clopidogrel resistance varies greatly depending on the method of measuring platelet aggregation and the definition of resistance. Rates of 8-18% were obtained using our methods and criteria.
    Download PDF (288K)
  • Hideo Yasunaga, Hiromasa Horiguchi, Kazuaki Kuwabara, Hideki Hashimoto ...
    2011 Volume 50 Issue 1 Pages 37-42
    Published: 2011
    Released on J-STAGE: January 01, 2011
    Objective Tsutsugamushi disease (scrub typhus) is caused by Orientia tsutsugamushi, and has been endemic in Asia and Western Pacific islands. Though sporadic case reports have described the clinical consequences of this vector-borne disease, data on the actual incidence of complications or mortality are scarce. It also remains unclear how a delay in effective treatments affects the occurrence of complications associated with this Rickettsial disease.
    Methods Using the Japanese Diagnosis Procedure Combination inpatient database in Japan, we identified patients with Tsutsugamushi disease between July 1 and December 31 in 2007 and 2008. We examined location of hospitals, patient's age, sex, comorbidities, complications, inhospital deaths, date of admission, date of starting therapy with tetracyclines. A logistic regression was conducted to analyze the association between delay in effective treatments and the occurrence of complications.
    Results A total of 210 cases were identified. Overall, 29 (13.8%) had at least one complication and two deaths were identified. Age was a significant risk factor for complications [odds ratio (OR), 1.48; 95% confidence interval (CI), 1.08-2.03; p=0.014, for a 10-year age increase]. Patients with ≥2 days delay in treatment with tetracyclines had a significantly higher risk of complications compared to those with no delay (OR, 2.71; 95% CI, 1.03-7.12; p=0.044).
    Conclusion Tsutsugamushi disease remains a threat to public health. Our study clearly indicates the importance of early diagnosis and immediate tetracycline treatment to prevent severe complications in Tsutsugamushi disease.
    Download PDF (128K)