Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
50 巻, 20 号
  • Kazuko Beppu, Taro Osada, Akihito Nagahara, Kenshi Matsumoto, Tomoyosh ...
    2011 年 50 巻 20 号 p. 2263-2267
    発行日: 2011年
    公開日: 2011/10/15
    ジャーナル オープンアクセス
    Background and Aim The incidence of ischemic colitis (IC) in Japan has been increasing due to the westernization of diet and the aging population. The aim of this study was to evaluate the relationship between endoscopic findings and clinical severity in IC.
    Methods This retrospective analysis included 106 cases diagnosed with IC that were divided into two groups based on endoscopic findings in the acute stage: redness and erosion (RE) versus longitudinal and circumferential ulcers (LCU). The clinical variables were compared between the two groups. In addition, we investigated the risk factors of IC associated with the severity of the endoscopic findings by multivariate logistic regression analysis.
    Results The percentage of cases presenting abdominal pain was significantly higher in the LCU group than that in the RE group (p=0.002), as were the baseline serum CRP levels (p=0.0001). The periods of hospitalization in LCU group were longer than in the RE group (p=0.0001). Multivariate logistic regression analysis indicated that ischemic heart disease (IHD) and connective tissue disease were the independent explanatory factor associated with the endoscopic severity of IC (p<0.05).
    Conclusion We showed clearly that the two endoscopic classifications were accurate indicators of severity and could be used to anticipate severity of IC. Furthermore, we confirmed that IHD and connective tissue disease were the exacerbating factor associated with the severity of endoscopic findings in IC.
  • Yoshikazu Kinoshita, Tsutomu Chiba, The FUTURE Study Group
    2011 年 50 巻 20 号 p. 2269-2276
    発行日: 2011年
    公開日: 2011/10/15
    ジャーナル オープンアクセス
    Objective To clarify the clinical characteristics of patients diagnosed with chronic gastritis in Japan, a large scale clinical survey of patients with chronic upper gastrointestinal symptoms was conducted. Patients diagnosed with functional dyspepsia (FD) according to the ROME III criteria were selected from among patients with chronic gastritis and the clinical characteristics of patients with FD and those with chronic gastritis were compared.
    Patients and Methods Patients with upper abdominal symptoms and diagnosed with chronic gastritis were enrolled in the study. Their main complaints, duration of symptoms, clinical characteristics, mental state, and results of endoscopic examinations, if available, were prospectively surveyed. Quality of life (QOL) impairment caused by abdominal symptoms was also surveyed using the Izumo QOL scale.
    Results A total of 9,125 patients with a clinical diagnosis of chronic gastritis were enrolled in the survey. Of those, approximately 60% had more than 2 symptoms and QOL impairment was greater in cases with multiple symptoms. Endoscopic examinations were performed in 2,946 cases (32.3% of enrolled patients), during which gastric and/or esophageal carcinoma was found in only 0.2%, though organic diseases were found in 6.2%. Endoscopic examinations were not done for patients with high risks of organic diseases. Of patients with organic diseases excluded by an endoscopic examination, only 362 (12.3% of patients who underwent an endoscopy) were diagnosed with FD according to the ROME III criteria, mainly because of short symptom duration. There were no remarkable differences in regard to clinical characteristics, including symptoms and mental state, between patients with chronic gastritis and those with FD.
    Conclusion Clinical characteristics of patients with chronic gastritis were similar to those with FD, except for shorter symptom duration.
  • Kazuyuki Chibana, Yoshiki Ishii, Yukitaka Anraku, Takeshi Fukuda
    2011 年 50 巻 20 号 p. 2277-2283
    発行日: 2011年
    公開日: 2011/10/15
    ジャーナル オープンアクセス
    Objective Physicians have provided care to only 0.2 million of the 5.3 million Japanese over the age of 40 years old who have chronic obstructive pulmonary disease (COPD). Among such individuals, many patients with respiratory symptoms diagnosed as chronic bronchitis (CB) are prescribed mainly expectorants. To determine the current status of COPD subjects diagnosed with and treated for CB, we investigated the prevalence of airflow limitation (AFL) in CB patients diagnosed by general practitioners (GPs) and the therapies administered to them.
    Methods Patients receiving treatment by GPs as CB completed a questionnaire and the FEV1/FEV6 ratio was measured by their GPs with a Piko-6. The prevalence of AFL (FEV1/FEV6 <73%) and the correlation between FEV1/FEV6 and FEV1/FVC were examined. Prescription behavior and comorbid lifestyle diseases were also examined.
    Results Data from 197 patients with CB were analyzed. Among those who underwent spirometry, the correlation between FEV1/FVC and FEV1/FEV6 was r2=0.38 (p<0.0001), and the sensitivity and specificity of the Piko-6 were 85.7% and 61.1%, respectively. The prevalence of AFL was 47.2% and increased to 54.1% among patients aged 70-79 years. Expectorants were prescribed for 39.8% of CB patients with AFL, but inhaled bronchodilators were prescribed for only 22.6%. Smoking history and age were significantly higher in the group with AFL than in those without AFL (p<0.05). The prevalence of comorbid lifestyle diseases was 73.1% in patients with AFL.
    Conclusion AFL was prevalent among patients with CB. Therefore, GPs should test pulmonary function in CB patients to ensure that the appropriate therapy is administered.
  • Wakoh Takahashi, Yuuko Tsukamoto, Tomohide Ohnuki, Shunya Takizawa, Sh ...
    2011 年 50 巻 20 号 p. 2285-2289
    発行日: 2011年
    公開日: 2011/10/15
    ジャーナル オープンアクセス
    Objective Renal dysfunction may be related to cerebrovascular disease. The aim of this study was to assess the relationship between mild renal dysfunction and carotid artery atherosclerosis detected by ultrasonography in apparently healthy subjects.
    Methods A total of 2,106 persons (1,368 men and 738 women, mean age+/-S.D.: 56 +/- 10 years) with no history of stroke were enrolled. Kidney function was evaluated in terms of estimated glomerular filtration rate (eGFR), calculated by using the relationship 194Cr-1.094×Age-0.287×0.739 (if female), where Cr is serum creatinine concentration. Atherosclerosis on ultrasonography was defined as regional intimal thickening or nodular lesion.
    Results Atherosclerotic lesions were significantly more frequent in subjects with CKD stage 3 than in CKD stage 1 or 2 (p<0.001). Odds ratios for atherosclerotic lesions were significantly increased to 1.11 (95% confidence interval: 1.09-1.12, p<0.001) for increasing age, 1.66 (1.31-2.10, p<0.001) for male sex, 1.76 (1.43-2.16, p<0.001) for systolic blood pressure ≥130 mmHg and/or diastolic blood pressure ≥85 mmHg, 1.61 (1.28-2.01, p<0.001) for LDL-cholesterol ≥140 mg/dL, and 1.59 (1.23-2.05, p=0.003) for smoking habit versus no risk factor. The odds ratio of CKD stage 3 for ≥50% carotid artery stenosis was significantly increased to 3.47 (1.09-11.08, p=0.035), although CKD stage 2 and stage 3 were not significant (0.77, 95% CI: 0.59-1.01, p=0.068; 0.99, 95%CI: 0.67-1.46, p=0.981, respectively).
    Conclusion Renal dysfunction defined in terms of eGFR might be associated with early-stage carotid atherosclerosis, but traditional vascular risk factors, including increasing age or hypertension, appear to play a major role.
  • Eiji Kitamura, Mieko Ogino
    2011 年 50 巻 20 号 p. 2291-2295
    発行日: 2011年
    公開日: 2011/10/15
    ジャーナル オープンアクセス
    Objective We clarified the prevalence of cholelithiasis/cholecystitis in long-term tracheostomy invasive ventilation (TIV) patients in our hospital.
    Methods We investigated the occurrence of cholelithiasis/cholecystitis in twenty-seven TIV patients over the past eight years.
    Results There were ten patients with cholelithiasis/cholecystitis. The underlying disease was amyotrophic lateral sclerosis (ALS), except for 1 patient. Mean age was 56.2 ± 4.7 years and the average period to the attack of cholelithiasis/cholecystitis from TIV was 57.6 ± 15.1 months. Two patients of acute cholecystitis had acalculous cholecystitis. Five of the ten patients developed a severe state of cholecystitis and needed aggressive therapy.
    Conclusion The prevalence of gallstones, symptom prevalence of asymptomatic cholelithiasis, the percentage of acalculous cholecystitis of acute cholecystitis in TIV patients was higher than in the general population. Therefore, it may be possible that TIV is a risk for cholelithiasis/cholecystitis. Some of the ALS patients with long-term TIV develop severe cholelithiasis/cholecystitis, and those facts should be considered in our daily clinical practice.
  • Kouichi Tomita, Norio Otani, Fumio Omata, Shinichi Ishimatsu
    2011 年 50 巻 20 号 p. 2297-2301
    発行日: 2011年
    公開日: 2011/10/15
    ジャーナル オープンアクセス
    Background Plasma ammonia has been used in emergency departments to assess whether or not generalized convulsion attacks exist in patients who are suspected of having convulsions. However, there are few reports that have assessed the relationship between generalized convulsions and hyperammonemia. The clinical significance of plasma ammonia measurements in the diagnosis of generalized convulsions is investigated in this study.
    Objective A total of 293 patients who were transported by ambulance to the emergency department of St. Luke's International Hospital, Tokyo, Japan under suspicion of convulsive seizure or disturbance of consciousness were studied.
    Methods The objectives were divided into two groups -"Convulsion" and "Non-convulsion"- according to the information provided by witnesses. Bivariate and multivariate analyses were carried out for patient background, clinical course, past medical history and blood test results.
    Results All 11 items showing significant differences on the bivariate analysis were included in the multivariate analysis. Of these, age, total Glasgow Coma Scale score, plasma ammonia level and arterial lactate level showed a significant difference and are recognized as independent findings for the diagnosis of generalized convulsion. The plasma ammonia level had an odds ratio of 14.8 (95% CI, 3.2 to 111.5; p<0.01), 53% sensitivity and 90% specificity when 65 μg/dL was used as the cut-off value.
    Conclusion Plasma ammonia values rise during generalized convulsion. Measurement of plasma ammonia is clinically highly significant as an independent finding during the diagnosis of generalized convulsion.
  • Takefumi Hitomi, Akio Ikeda, Morito Inouchi, Hisaji Imamura, Tomokazu ...
    2011 年 50 巻 20 号 p. 2303-2309
    発行日: 2011年
    公開日: 2011/10/15
    ジャーナル オープンアクセス
    Objective To clarify the clinical features and mechanism of the transience of myoclonus in patients with a transient myoclonic state with asterixis (TMA).
    Methods We investigated the clinical and eletrophysiological profiles of 6 patients with TMA (age: 84±3 years). During an asymptomatic period, somatosensory evoked potentials (SEPs) were recorded in all 6 patients and motor evoked potentials (MEPs) were examined in 1 patient. SEPs were recorded and jerk-locked back averaging (JLA) was performed in 2 patients while symptomatic. SEPs were also recorded from 8 aged control subjects (age: 68±5 years).
    Results All TMA patients had mild chronic systemic diseases. During an asymptomatic period, SEP amplitudes were not significantly enlarged in comparison with control subjects, and MEPs were normal. Examination of 2 patients during symptomatic period indicated no enlargement of SEP amplitudes and JLA disclosed a positive spike preceding myoclonic jerks. In one of these patients, the amplitude of the positive spike decreased once myoclonus improved.
    Conclusion TMA occurred in aged patients with mild chronic systemic diseases. JLA findings and the absence of giant SEPs further support that TMA is a cortical non-reflex myoclonus. In addition, transient hyperexcitability at the primary motor cortex disclosed by JLA correlated well with its transient symptoms.
  • Kenichi Kashihara, Ayumi Hanaoka, Takaki Imamura
    2011 年 50 巻 20 号 p. 2311-2315
    発行日: 2011年
    公開日: 2011/10/15
    ジャーナル オープンアクセス
    Objective Patients with Parkinson's disease (PD) frequently complain of a diminished sense of smell. Less frequently, they may complain of taste impairment. In the present study, we investigated the symptoms, frequency, and severity of taste impairment as well as smell impairment in PD patients and compared the results with those of age- and sex-matched healthy controls.
    Patients and Methods We interviewed 285 PD patients (120 men, 165 women) without dementia or nasal problems. Control subjects comprised 61 (20 men, 41 women) healthy spouses of the PD patients. Alteration of smell and taste sense lasting more than 3 months was defined as abnormal.
    Results One hundred and sixteen patients with PD complained of smell impairment and 26 complained of taste impairment. Only 5 controls complained of smell impairment, and no control subjects reported taste impairment. Taste impairment was more marked in patients with smell impairment. Impaired taste included diminished taste perception in 21 patients, altered sense of taste in 4 patients and burning mouth in 1 patient.
    Conclusion Taste as well as smell perception is impaired in patients with PD. The frequency of smell and taste impairments tended to increase with disease progression.