Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
Volume 51 , Issue 11
Showing 1-37 articles out of 37 articles from the selected issue
EDITORIAL
ORIGINAL ARTICLES
  • Hideyuki Chiba, Toshiaki Gunji, Hajime Sato, Kimiko Iijima, Kazutoshi ...
    2012 Volume 51 Issue 11 Pages 1293-1299
    Published: 2012
    Released: June 01, 2012
    JOURNALS OPEN ACCESS
    Objective To investigate the impact of metabolic and lifestyle factors on erosive esophagitis in young adults.
    Methods A total of 5,069 people under the age of 40 years old were enrolled in a medical survey at our institute. People with a previous history of upper gastrointestinal tract surgery were excluded, as were individuals taking medication for reflux symptoms, peptic ulcers, or malignancies. Independent and significant predictors affecting the presence of erosive esophagitis were determined by multivariate analysis.
    Results A total of 4,990 participants (male/female; 3,871/1,119, age; 33.9±3.9 years) were eligible. A total of 728 participants (14.6%) had erosive esophagitis. Male gender and increasing age were independent predictors for increased prevalence of erosive esophagitis (odds ratio=2.242 and 1.045. 95% confidence interval=1.613-3.117 and 1.019-1.072; p<0.001 and 0.001, respectively). Moderate-to-heavy alcohol consumption, light-to-moderate-to-heavy smoking, hypertension, hyperglycemia, and hiatal hernia each significantly and independently increased the risk for erosive esophagitis (odds ratio=1.499, 1.398, 1.353, 1.570, 1.884, 1.297, 1.562, and 3.213. 95% confidence interval=1.181-1.903, 1.040-1.880, 1.094-1.675, 1.250-1.971, 1.307-2.716, 1.074-1.566, 1.063-2.295, and 2.712-3.807; p=0.001, 0.027, 0.005, <0.001, 0.001, <0.001, 0.007, 0.023, and <0.001 respectively). Helicobacter pylori infection decreased the risk for erosive esophagitis (odds ratio=0.575, 95% confidence interval =0.436-0.759 p<0.001). Neither body mass index nor waist girth conferred increased risk of erosive esophagitis after adjusting for potential confounding factors.
    Conclusion Risk of erosive esophagitis in Japanese young adults was not increased by obesity, but it was increased by hiatal hernia and metabolic and lifestyle profiles including hypertension, hyperglycemia, alcohol consumption and smoking.
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  • Noritoshi Kobayashi, Takamitsu Sato, Shingo Kato, Seitaro Watanabe, Ku ...
    2012 Volume 51 Issue 11 Pages 1301-1307
    Published: 2012
    Released: June 01, 2012
    JOURNALS OPEN ACCESS
    Objectives The aim of this study was to characterize the pancreatic cystic lesions in von Hippel-Lindau (VHL) disease and to document the changes that occur in the pancreas.
    Methods We retrospectively analyzed the medical records and the computed tomography (CT) and magnetic resonance imaging (MRI) findings of 20 VHL patients who were diagnosed between 1996 and 2010 at our hospital. The clinical findings, family history and type of tumors and/or cysts were reviewed for each patient. We also analyzed the imaging findings for the pancreas in detail.
    Results Pancreatic involvement was noted in 16 of the 20 patients (80%). Eleven patients had multiple cysts diffusely distributed in the pancreas, and one patient had a single cyst in the pancreas head. Two patients had serous cystic neoplasms (SCNs) with multiple cysts, and another two patients had neuroendocrine tumors (NETs) which were conventional radiological findings. The largest cysts of four patients (26.7%) increased in size and that of three patients (20%) decreased in size during the follow-up period. We performed surgical resections for the pancreatic tumors (one NET and one SCN) and also performed endoscopic treatment for a pancreatic cyst in one VHL patient with obstructive jaundice. None of the patients died as a result of pancreatic disease.
    Conclusion The most common type of pancreatic lesions was multiple cysts. SCNs were present in only 10% of the VHL patients. Pancreatic cysts showed positive and/or negative growth according to the CT and MRI findings. The pancreatic cystic lesions did not influence the outcome of the VHL patients.
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  • Satoru Takeuchi, Kojiro Wada, Kimihiro Nagatani, Hideo Osada, Naoki Ot ...
    2012 Volume 51 Issue 11 Pages 1309-1313
    Published: 2012
    Released: June 01, 2012
    JOURNALS OPEN ACCESS
    Objective Hydrogen selectively reduces hydroxyl radicals and peroxynitrite, and numerous experimental and clinical studies suggest that hydrogen can exert potent cellular protective effects against a wide variety of diseases. Furthermore, there is increasing evidence that antioxidants can modulate platelet activation. The aim of the present study was to investigate the relationship between hydrogen and collagen-induced platelet aggregation.
    Methods For human ex vivo studies, we collected blood samples from six healthy humans and added normal saline or hydrogen-rich saline to blood and platelet-rich plasma. We found that collagen (1 μg/mL)-induced platelet aggregation was significantly inhibited by hydrogen-rich saline compared with a normal saline group (p=0.044). For rat in vivo studies, animals (n=17) were exposed to either nitrogen-based mixed gas with hydrogen (H2 gas group; n=9) or without hydrogen (non-H2 gas group; n=8). Additionally, another animals (n=13) administered either normal (NS group; n=7) or hydrogen-rich saline (HS group; n=6) (5 ml/kg) via intravenous infusion. Blood samples were drawn from the vena cava before treatment and from the right ventricle after treatment. Collagen (12 μg/mL)-induced platelet aggregation was then measured.
    Results Collagen-induced platelet aggregation was significantly decreased in H2 gas and HS group rats (p=0.042, 0.018, respectively), while there was no difference in non-H2 gas and NS group rats before and after treatment.
    Conclusion In summary, these data suggest that hydrogen may inhibit collagen-induced platelet aggregation.
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  • Hiroaki Matsumoto, Yuko Murase-Mishiba, Naomune Yamamoto, Saya Sugitat ...
    2012 Volume 51 Issue 11 Pages 1315-1321
    Published: 2012
    Released: June 01, 2012
    JOURNALS OPEN ACCESS
    Background Since serum albumin is glycosylated more rapidly than hemoglobin, it is possible that the glycated albumin (GA) to HbA1c ratio (GA: HbA1c ratio) is potentially a more sensitive indicator of blood glucose excursion than HbA1c. The aim of the present study was to assess the clinical usefulness of GA: HbA1c ratio as a marker of daily glucose excursions in patients with type 1 diabetes according to the subtypes; acute onset type 1A, fulminant and slowly progressive type 1 diabetes.
    Methods Fifty-six outpatients with type 1 diabetes [16 fulminant, 20 acute-onset type 1A and 20 slowly progressive (SPIDDM)] were recruited consecutively. Each patient performed self-monitoring of blood glucose at seven points a day. The associations among the daily profile of glucose and GA, HbA1c, GA: HbA1c ratio were examined across and within the subtypes of type 1 diabetes.
    Results GA and GA: HbA1c ratio were each independently correlated with mean amplitude of glucose excursion (MAGE) in patients with type 1 diabetes (F=27.53, p<0.001 and F=13.02, p<0.001, respectively). GA: HbA1c ratio was significantly higher in fulminant type 1 diabetic patients than in SPIDDM patients (3.5 ± 0.2 vs. 3.2 ± 0.5, p=0.015) and it was independently associated with MAGE within fulminant type 1 diabetes (F=21.2, p<0.001).
    Conclusion In conclusion, the present study demonstrated that GA: HbA1c ratio could be a better marker for glycemic variability than HbA1c in type 1 diabetes, especially in fulminant type 1 diabetes.
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  • Naoki Nakagawa, Maki Kabara, Motoki Matsuki, Junko Chinda, Takayuki Fu ...
    2012 Volume 51 Issue 11 Pages 1323-1328
    Published: 2012
    Released: June 01, 2012
    JOURNALS OPEN ACCESS
    Objective Tonsillectomy and steroid-pulse (TSP) therapy have been proposed as a curative treatment for immunoglobulin A nephropathy (IgAN) in Japan. However, we sometimes encounter patients who reject steroid-pulse therapy because of concerns about the side effects of corticosteroids. Here, we examined the efficacy of TSP therapy and tonsillectomy alone for IgAN with urinary abnormalities.
    Methods Data on 40 IgAN patients diagnosed by renal biopsies, who presented glomerular hematuria and proteinuria at baseline and underwent bilateral palatine tonsillectomy, were analyzed retrospectively. Twenty of them underwent TSP therapy (TSP group), and 20 underwent tonsillectomy alone (T group). We examined associations between therapies, changes in urinary findings and renal function, and subsequent clinical remission (CR), defined as negative proteinuria and urinary erythrocytes of less than 5/high-power field.
    Results TSP group showed a significant decrease in proteinuria and hematuria earlier than T group. The rates of CR were significantly higher in TSP group compared with T group on the final observation period (75% vs. 45%, p<0.05). There was a significant difference between CR group and non-CR group only in the rate of receiving TSP therapy.
    Conclusion TSP therapy significantly increased the probability of CR compared with tonsillectomy alone in IgAN patients with urinary abnormalities.
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  • Teruaki Nishiuma, Hisashi Ohnishi, Naoko Katsurada, Satomi Yamamoto, S ...
    2012 Volume 51 Issue 11 Pages 1329-1333
    Published: 2012
    Released: June 01, 2012
    JOURNALS OPEN ACCESS
    Objective A retrospective evaluation of the effectiveness of simple aspiration therapy in primary spontaneous pneumothorax was carried out.
    Methods We enrolled 143 patients with mild and moderate primary spontaneous pneumothorax between June 2006 and October 2010. Clinical backgrounds and therapeutic results from 92 patients that underwent simple aspiration therapy were assessed.
    Results All patients were treated safely without any serious complications. With the exception of one patient with an unknown result, the initial success rate after three days was 72.5% (66 out of 91 patients). Chest X-ray analysis at the first medical examination showed that the success rate was significantly low in patients with a larger vertical rim between the apex and top of the lung and a higher collapsed area ratio; in particular, the success rate was markedly decreased in cases that exceeded 8 cm and 50%, respectively. No significant difference was observed in the aspiration volume, however, the success rate was lower when the aspiration volume was more than 1,500 mL. The recurrence rate at one year was 36.4% (24 out of 66 successfully treated patients).
    Conclusion Our results are nearly identical to previous reports from other countries and show that simple aspiration has proved to be a safe and effective therapy.
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  • Akiko Aoki, Motoyoshi Nagate, Kenta Utsumi, Asashi Tanaka, Yuichi Inou ...
    2012 Volume 51 Issue 11 Pages 1335-1340
    Published: 2012
    Released: June 01, 2012
    JOURNALS OPEN ACCESS
    Objective We evaluated the relationship between somatic symptoms and depressive conditions among patients visiting the general medicine clinic of a university hospital.
    Methods We distributed interview forms to 332 consecutive patients who visited our clinic for the first time between March and July 2011. Somatic symptoms were rated using a symptom checklist, and depressive conditions were evaluated using the Zung Self-Rating Depression Scale (SDS). We categorized and compared 2 groups of patients: patients with an SDS score of more than 48 (depressive group) and patients with an SDS score of less than 48 (non-depressive group).
    Results A total of 284 (85.5%) patients returned the forms. The SDS scores were obtained from the forms of 182 patients (64.1%). The average age of these 182 patients was 46.5±18.04 years. The mean number of checked symptoms was 4.3±3.03, and the most common symptom was general fatigue (n=106; 58.2%). The number of checked symptoms in the survey was higher in the depressive group patients than in the non-depressive group patients. Multiple logistic regression analysis indicated that general fatigue, headache, and sleeping problems were significant dependent variables which were related to depressive conditions. We defined these 3 symptoms as depression-related somatic symptoms (DRSS). On a receiver-operating characteristic curve, the optimal cutoff scores were 2 of 3 DRSS and 4 of 20 somatic symptoms.
    Conclusion General physicians should consider possible depressive conditions when patients have 2 or more DRSS or 4 or more somatic symptoms.
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