Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
Volume 51, Issue 12
Displaying 1-39 of 39 articles from this issue
  • Teppei Ohmori, Hiroyuki Konishi, Shinichi Nakamura, Keiko Shiratori
    2012 Volume 51 Issue 12 Pages 1455-1460
    Published: 2012
    Released on J-STAGE: June 15, 2012
    Objective Many patients on hemodialysis for chronic renal failure suffer from progressive anemia. In hemodialysis patients with gastrointestinal bleeding, endoscopic examination often fails to identify hemorrhagic lesions. We surveyed hemodialysis patients with obscure gastrointestinal bleeding (OGIB) for the presence of intestinal lesions by capsule endoscopy (CE).
    Methods Among 90 patients who underwent CE, 13 had hemodialysis-related anemia (8 men and 5 women, age 66.5±7.9 years, Hb 8.8±1.9 g/dL, mean ± SD) and 77 had non-hemodialysis anemia (47 men and 30 women, age 55.7±19.9 years, Hb of 11.9±3.1 g/dL). The types and distribution of hemorrhagic lesions were investigated by CE. All patients had signs or symptoms of gastrointestinal bleeding but no active bleeding site was detected by endoscopy. The CE-observed lesions were classified into reddening, erosions/ulcers, vascular lesions, and tumors. The characteristic features of each lesion and patient demographic data were compared.
    Results Vascular lesions were significantly more frequent in the hemodialysis group than in the controls (p<0.001). Reddening was observed in all patients of the hemodialysis group and mainly found in the ileum. Erosions/ulcers were observed in 4 patients (30.7%) and were more frequent in the jejunum. Vascular lesions were observed in 8 patients (61.5%) and they were more frequent in the ileum. A submucosal tumor was seen in one patient. There were no significant differences in demographic factors between patients with erosions/ulcers and those with a vascular lesion.
    Conclusion Vascular lesions are common in anemic hemodialysis patients with OGIB and should be considered in the differential diagnosis of anemia in patients on hemodialysis with OGIB.
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  • Tetsuro Yamazato, Tsuneo Oyama, Toshifumi Yoshida, Yasumasa Baba, Kohe ...
    2012 Volume 51 Issue 12 Pages 1461-1465
    Published: 2012
    Released on J-STAGE: June 15, 2012
    Objective Early detection of gastric cancer by screening endoscopy facilitates endoscopic treatment in place of open surgery. The aim of this study was to evaluate whether 2 years intensive training improved the detection of gastric cancer by screening endoscopy.
    Methods An endoscopist who had trained for 6 years as a general physician, performed screening endoscopy at Imari Arita Kyoritsu Hospital before (group I) and after (group II) intensive training in the diagnosis of early gastric cancer in consecutive patients.
    Results Background characteristics, including age (61.6 vs. 62.2 years) and sex, did not differ between the groups. Before training, 10 gastric neoplasms were detected in 937 patients in group I: four early gastric cancers, one gastric adenoma, and five advanced gastric cancer. After training, 36 gastric neoplasms were detected in 937 patients in group II: 18 early gastric cancers, 11 gastric adenoma, five advanced gastric cancer, and one each of gastric carcinoid and malignant lymphoma. The detection rate for early gastric cancer was significantly improved by training [group I: 4/937 (0.4%) vs. group II: 18/937 (1.9%)], although the detection rate for advanced gastric cancer did not differ before and after training. The proportion of early gastric cancer + adenoma to advanced cancer was higher in group II (5/5 vs. 29/5 in group I).
    Conclusion Intensive training in upper gastrointestinal endoscopy screening dramatically improved the detection rate for early gastric cancer, although the detection rate for advanced gastric cancer was not affected.
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  • Tohru Yoshizaki, Ken Umetani, Yuri Ino, Souichirou Takahashi, Masahiko ...
    2012 Volume 51 Issue 12 Pages 1467-1471
    Published: 2012
    Released on J-STAGE: June 15, 2012
    Objective The purpose of this study was to investigate the relationship between the new onset of atrial fibrillation (AF) and inflammation in the early phase of acute myocardial infarction (AMI).
    Background Serial interaction between inflammation and the incidence of AF is not fully understood in the early phase of AMI.
    Methods Two hundred fifty-nine consecutive patients with AMI were studied. electrocardiogram monitoring was recorded continuously for >7 days. Serial inflammation markers, cardiac enzymes, coronary angiogram and echocardiography were obtained in all patients.
    Results One hundred seventy-six patients were enrolled. AF was present in 24 patients (14%), and occurred on day 2.7±1.4 after admission. Serial measurements of WBC and C-reactive protein (CRP) with/without AF were as follows. WBC levels of day 5-7 were 9.3±3.5 vs. 7.5±2.4×103/μL, p=0.04, and CRP levels of day 2-4, 5-7, 8-14 were 12.6±9.4 vs. 4.7±5.3 mg/dL, p<0.001, 12.3±10.4 vs. 5.2±5.2 mg/dL, p=0.01, and 8.5±7.7 vs. 2.7±4.2 mg/dL, p=0.005, respectively. Those were significantly higher in the patients with AF. In multivariate logistic regression analysis, CRP levels of day 2-4 were independently higher in the patients with AF (odds ratio (OR) 1.15, 95% confidence (CI) 1.04-1.27).
    Conclusion AF in the early phase of AMI occurs a few days after the onset of AMI, which is independently related to the activated inflammation. AF in this period persists for only a short duration.
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  • Eri Hasegawa, Takuya Tsuchihashi, Yuko Ohta
    2012 Volume 51 Issue 12 Pages 1473-1478
    Published: 2012
    Released on J-STAGE: June 15, 2012
    Objective Hypertension guidelines recommend strict blood pressure (BP) control to less than 130/80 mmHg in patients complicated with chronic kidney disease (CKD). However, it is unclear whether this target BP level is applicable to the elderly hypertensive patients. The aim of this study was to assess the prevalence of CKD and BP control status in elderly hypertensive patients.
    Methods Subjects were 675 hypertensive patients (65.5±11.7 years, 290 males and 385 females). Prevalence of CKD and BP control status were compared between elderly and young/middle-age patients.
    Results Average BP of elderly and young/middle-age patients were 134±10/71±9 mmHg and 131±11/78±9 mmHg, respectively. CKD was more prevalent in the elderly than in the young/middle-age patients (35.5% and 24.5%, respectively). The elderly patients with CKD were more likely to be males and older. They also required a greater number of antihypertensive drugs than those without CKD (2.4±1.2 vs. 2.0±1.1, p<0.01). Elderly patients without CKD who achieved a target BP of <140/90 mmHg were 73.2%. Similarly, 78.5% of the patients with CKD achieved BP of <140/90 mmHg, while those who achieved <130/80 mmHg were only 29.6%.
    Conclusion Our results suggest that CKD is frequently complicated in elderly hypertensive patients, and many of them failed to achieve strict BP goal in spite of the average use of 2.4 antihypertensive drugs.
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  • Junichi Shizuku, Tetsuri Yamashita, Takashi Ohba, Takashi Kabaya, Kosa ...
    2012 Volume 51 Issue 12 Pages 1479-1485
    Published: 2012
    Released on J-STAGE: June 15, 2012
    Objective An enlarged left atrium (LA) has recently been identified as a risk factor for adverse cardiovascular outcomes in various pathologic conditions. However, few studies have evaluated its prognostic value in hemodialysis (HD) patients.
    Methods We conducted an observational study to investigate whether an enlarged LA predicted all-cause mortality in 174 HD patients. Patients were stratified into two groups based on the LA volume index (LAVI) value of 32 mL/m2.
    Results An increased left atrial volume index (LAVI >32 mL/m2) was present in 28 (16.1%) of the HD patients. During the follow-up period (50.1±22.4 months), 77 patients (44.3%) died. A Kaplan-Meier analysis revealed that the 7-year survival rate was significantly lower in the group whose LAVI was >32 mL/m2 than in the group whose LAVI was ≤32 mL/m2 (p=0.0033). Multivariate analyses adjusted for echocardiographic parameters and clinical and laboratory data showed that increased LAVI was an independent predictor of all-cause mortality (hazard ratio 1.030, 95% confidence interval 1.004-1.056, p=0.0260). Moreover, increased LAVI had a higher predictive value for all-cause mortality (area under the receiver operating characteristic curve=0.612, p=0.0059) among the measured echocardiographic parameters.
    Conclusion The results of the present study suggested that measurement of LAVI may be helpful in the risk stratification of HD patients and in providing therapeutic direction for their management.
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  • Shinji Abe, Arata Azuma, Hiroshi Mukae, Takashi Ogura, Hiroyuki Tanigu ...
    2012 Volume 51 Issue 12 Pages 1487-1491
    Published: 2012
    Released on J-STAGE: June 15, 2012
    Objective The prognosis of idiopathic pulmonary fibrosis (IPF) patients with acute exacerbation (AE) is reported to be extremely poor. Several clinical studies suggest that direct hemoperfusion with polymyxin B-immobilized fiber (PMX) may have beneficial effects on AE in patients with interstitial pneumonia (IP). The aim of this multicenter retrospective analysis was to investigate whether PMX treatment could provide improvement of oxygenation and survival benefits in IPF patients with AE.
    Methods We conducted a retrospective study of 160 IP patients (including 73 IPF) with AE treated by PMX at 18 institutions in Japan. PMX treatment was carried out twice. The total hemoperfusion time of PMX treatment was, on average, 12 hours. Data concerning oxygenation on PMX treatment and survival after AE were collected and analyzed.
    Results In IPF patients with AE, arterial oxygen tension (PaO2)/inspiratory oxygen fraction (FiO2), (P/F) ratio was significantly improved at the end of the 2nd treatment with PMX (173.9±105.4 to 195.2±106.8 Torr, p=0.003). White blood cell count was significantly reduced at the end of the 2nd treatment (13,330±7,002 to 9,426±5,188 /mm3, p<0.001). These clinical changes were also observed on analysis of all 160 IP patients with AE. The one- and three-month survival rates of IPF patients after AE were 70.1% and 34.4%, respectively.
    Conclusion PMX treatment may improve oxygenation and survival in IPF patients with AE. Prospective, controlled trials of PMX treatment for IPF with AE are warranted to verify this potential benefit.
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  • Ko-suke Naito, Kazuhiro Fukushima, Seiko Suzuki, Motoi Kuwahara, Hiros ...
    2012 Volume 51 Issue 12 Pages 1493-1500
    Published: 2012
    Released on J-STAGE: June 15, 2012
    Background Neuralgic amyotrophy (NA) is a distinct peripheral nervous system disorder characterized by attacks of acute neuropathic pain and rapid multifocal weakness and atrophy unilaterally in the upper limb. The current hypothesis is that the episodes are caused by an immune-mediated response to the brachial plexus, however, therapeutic strategies for NA have not been well established.
    Methods and Results We retrospectively reviewed 15 case series of NA; 10 of the 15 patients received intravenous immunoglobulin (IVIg) with methylprednisolone pulse therapy (MPPT) and 9 of these10 patients showed clinical improvement of motor impairment.
    Conclusion Our clinical observations do not contradict the possibility that IVIg with MPPT may be one of the potential therapeutics for NA, however the efficacy remains to be established. Further confirmatory trials are needed in patients with various clinical severities and phases of NA. Further basic research and confirmatory trials should be performed to survey the efficacy of such immunomodulation therapy for NA.
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  • Ken Ikeda, Takehisa Hirayama, Takanori Takazawa, Kiyokazu Kawabe, Yasu ...
    2012 Volume 51 Issue 12 Pages 1501-1508
    Published: 2012
    Released on J-STAGE: June 15, 2012
    Objective Previous studies have reported distinct serological profiles of lipid, urate and ferritin in Western patients with amyotrophic lateral sclerosis (ALS). We aimed to examine the levels of these serological factors and their relationship to disease progression in Japanese ALS patients.
    Methods Ninety-two patients with definite or probable ALS who fulfilled the revised El Escorial criteria were analyzed for clinical and serological variables. Serological data at the time diagnosed with ALS were compared to those of 92 age/sex/body mass index-matched healthy controls.
    Results Compared to controls, urate and creatinine (Cr) levels were decreased and ferritin levels were increased significantly in sera of male and female patients with ALS. Significant increases of serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and triglyceride levels were found in female ALS patients. The annual decline of ALS Functional Rating Scale-Revised (ALS-FRS) and forced vital capacity (FVC) were inversely correlated with serum TC, LDL-C, Cr and urate levels, and were positively correlated with serum ferritin levels. Multivariate analysis showed that the rapid worsening of annual ALS-FRS and FVC was associated with serum levels of TC, LDL-C, Cr, urate and ferritin.
    Conclusion The present study indicated that serum levels of TC, LDL-C, Cr, urate and ferritin were correlated with clinical deterioration in ALS patients. These results are similar to those in Western patients. Metabolic and nutritional conditions of lipid, urate and iron could contribute to disease progression in ALS patients. Further studies investigating high nutrition diets and iron chelation for the treatment of ALS are warranted.
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  • Minghao Ha, Guotong Zhang, Shu Diao, Mingfang Lin, Jianqiu Wu, Liping ...
    2012 Volume 51 Issue 12 Pages 1509-1515
    Published: 2012
    Released on J-STAGE: June 15, 2012
    Objective We aimed to compare the cumulative efficacy and resistance of ADV monotherapy, ADV add-on LAM (ADV + LAM), ADV and ETV (ADV + ETV) combination therapy in LAM-resistant patients.
    Methods Ninety-one adult CHB patients with LAM-resistance mutations (YMDD) were identified. Of these 91, 29 patients were treated with ADV monotherapy, 30 were treated with ADV + LAM and 32 were treated with ADV + ETV combination therapy, for at least 24 months.
    Results The mean serum HBV-DNA decreases from baseline at 3, 6, 12, and 24 months were -3.23, -4.41, -5.32, and -5.58 log10IU/mL in the ADV + ETV combination therapy groups, respectively; the most significant among the three treatment groups (p<0.01). The rate of HBV-DNA PCR undetectability (<60 IU/mL) at 6 months in ADV + ETV combination therapy was 78.1%; also the most significant among the three treatment groups (p=0.024). Viral breakthrough and genotypic mutations were detected in 8 (27.6%) and 4 (13.3%) patients in the ADV monotherapy and ADV+LAM therapy groups, respectively; whereas no case of viral breakthrough and genotypic resistance was detected in the ADV+ETV combination therapy group after 24 months (p<0.05).
    Conclusion ADV + ETV combination therapy demonstrated faster and significantly greater suppression of HBV DNA compared with ADV add-on LAM combination therapy for patients with LAM-resistance mutations. ADV + ETV was superior to ADV + LAM in achieving initial virological response and long-term suppression activity against HBV. ADV + ETV combination therapy was the most effective to refrain from selecting HBV strains with cross-resistance to three NAs (LAM, ADV and ETV) for LAM-resistance patients.
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  • Atsushi Yamada, Yasuo Takeuchi, Yuji Nishizaki, Hiroyuki Daida
    2012 Volume 51 Issue 12 Pages 1517-1521
    Published: 2012
    Released on J-STAGE: June 15, 2012
    Objective The present study was undertaken to determine the characteristics and outcome of in-hospital cardiac arrests and the effectiveness of BVM ventilation with airway adjuncts including the oropharyngeal airways and nasopharyngeal airways.
    Methods Information about in-hospital cardiac arrests over a period of 6 years was retrospectively collected, and the effectiveness of BVM ventilation with airway adjuncts was analyzed using a multivariate logistic regression model.
    Results During the study period, 105 (male, n=70; age, 68.6±14.2 years) cardiac arrests occurred, of which 95.2% developed among inpatients and 21.0% of them were witnessed. The initial rhythm of cardiac arrests was pulseless electrical activity in 63.8% (67/105) and respiratory failure (44.8%) was the most common cause. Overall, a return of spontaneous circulation occurred in 76.2% of in-hospital cardiac arrests, 31.4% survived to discharge, and the neurological outcome was good (cerebral performance category-1) in 66.7% of them. Bag-valve-mask ventilation with airway adjuncts improved the neurological outcome (OR 3.52, 95%CI 1.07, 11.5).
    Conclusion Bag-valve-mask ventilation with airway adjuncts improved neurological outcomes.
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