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Yu-Cheng Lin, Wei-Pin Lin, Jeng-Yi Huang, Shen-Yang Lee
2012 Volume 51 Issue 14 Pages
1841-1843
Published: 2012
Released on J-STAGE: July 15, 2012
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Patients undergoing continuous ambulatory peritoneal dialysis (CAPD) are at an increased risk of peritonitis following colonoscopy with or without polypectomy. Guidelines for peritoneal dialysis patients recommend administration of prophylactic antibiotics and drainage of the abdomen before colonoscopy. In this report, we describe a 53-year-old woman on CAPD who underwent colonoscopy with polypectomy and developed peritonitis within 24 hours. She presented with severe abdominal pain, typical rebounding tenderness, and turbid dialysate containing increased white blood cells with a predominance of neutrophils. A culture of the patient's peritoneal fluid grew polymicrobial species including
Escherichia coli,
Klebsiella pneumoniae, and
Enterococcus faecalis. She was treated with intraperitoneal and intravenous administration of combination antibiotics, and she fully recovered within 3 weeks. We suggest that nephrologists and endoscopists should be familiar with the risks and follow the guidelines to prevent such complications in CAPD patients. If peritonitis occurs, medical therapy with antibiotics should be considered before surgical intervention for catheter salvage.
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Yuichi Kimura, Keisuke Ohba, Hitoshi Sumida, Kenichi Tsujita, Toyoki H ...
2012 Volume 51 Issue 14 Pages
1845-1850
Published: 2012
Released on J-STAGE: July 15, 2012
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A 54-year-old man was referred to a local hospital, located about 90 km from our hospital, with cardiogenic shock due to left main coronary artery infarction (LMCA-MI). Percutaneous coronary intervention (PCI) was performed under intra-aortic balloon pumping (IABP) support, but resulted in insufficient reperfusion and his condition worsened. The helicopter emergency medical service (HEMS) rapidly transported the patient to our hospital. After percutaneous cardio-pulmonary support system (PCPS) insertion, PCI could establish the coronary flow. A series of intensive therapies saved the patient. The cooperation of medical and emergency service system following revascularization and intensive care saved the patient with LMCA-MI accompanied by cardiogenic shock.
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Shingo Kujime, Hidehiko Hara, Yoshinari Enomoto, Hisao Yoshikawa, Hide ...
2012 Volume 51 Issue 14 Pages
1851-1855
Published: 2012
Released on J-STAGE: July 15, 2012
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This report describes an obese 39-year-old man who experienced ST-segment elevation myocardial infarction with total thrombotic occlusion of the right coronary artery. Culprit vessel flow was improved by aspiration. Data suggested that myocardial infarction had resulted from paradoxical embolus via a patent foramen ovale triggered by the Mueller maneuver, which had induced negative intrathoracic pressure following an acute increase of right-heart volume in the context of obesity and sleep-disordered breathing (SDB). Obesity is increasing among younger populations and it represents a risk for SDB and thrombosis. Thus, this mechanism should be included within the differential diagnosis for myocardial infarction in young patients.
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Akinori Sato, Masaomi Chinushi, Hiroshi Suzuki, Fujito Numano, Takanor ...
2012 Volume 51 Issue 14 Pages
1857-1860
Published: 2012
Released on J-STAGE: July 15, 2012
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An 8-year-old boy suffered from an unconsciousness attack and torsade de pointes arrhythmia during sleep or at rest. His electrocardiogram showed prolonged QT intervals, but the T wave morphology was atypical for type 1, 2 or 3 congenital long-QT syndrome (LQTS). Intravenous epinephrine slightly prolonged the QT interval whereas mexiletine infusion shortened the QT interval. Although these clinical characteristics might suggest type 3 LQTS, a genetic analysis identified the G604S-KCNH2 mutation (type 2 LQTS). Because mismatches between the genotype and phenotype of LQTS are possible, genetic analysis of LQTS is important to identify the most appropriate therapeutic option and risk stratification.
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Naohiko Takahashi, Tetsuji Shinohara, Masahide Hara, Tetsunori Saikawa
2012 Volume 51 Issue 14 Pages
1861-1864
Published: 2012
Released on J-STAGE: July 15, 2012
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We encountered a 39-year-old man with documented ventricular fibrillation (VF). His ECGs showed intermittent Wolff-Parkinson-White (WPW) syndrome pattern. During electrophysiological study, no ventricular preexcitation was observed. An accessory pathway located at the posterior mitral annulus was identified, and successfully eliminated by radiofrequency catheter ablation. VF was not induced. His ECGs in the absence of delta waves demonstrated early repolarization in the inferior leads. This case raises the possibility that patients with manifest WPW syndrome may have an arrhythmogenic substrate associated with early repolarization, and the characteristic J waves can be masked by the presence of ventricular preexcitation.
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Rania Hammami, Leila Abid, Faten Frikha, Sameh Marzouk, Ahmed Tounsi, ...
2012 Volume 51 Issue 14 Pages
1865-1867
Published: 2012
Released on J-STAGE: July 15, 2012
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Intracardiac thrombosis is an exceptional complication of Behçet's disease. The management of this involvement is difficult due to the risk of recurrence. We present the case of a young man admitted to our hospital for intermittent fever. The microbiologic investigations did not show any causative germ. We discovered a right ventricle thrombus on echocardiography. We confirmed the diagnosis of pulmonary embolism on CT angiogram. The patient developed oral and genital ulcerations which were consistent with Behçet's syndrome. The thrombus had disappeared after treatment with anticoagulant, corticosteroid and immunosuppressors. Intracardiac thrombosis can reveal Behçet's disease. An exhaustive examination and close monitoring should be performed in order to reveal pathognomonic signs as soon as possible and to promptly start the appropriate treatment.
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Seigo Tachibana, Shinya Sato, Tadao Yokoi, Ryoko Nagaishi, Yuko Akehi, ...
2012 Volume 51 Issue 14 Pages
1869-1873
Published: 2012
Released on J-STAGE: July 15, 2012
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We herein report a case of severe postsurgical hypocalcemia associated with primary hyperparathyroidism (pHPT), Graves' disease (GD) and acromegaly (AC). A 54-year-old woman was referred to our clinic for treatment of pHPT and GD. She also had active AC and was clinically diagnosed as multiple endocrine neoplasm type 1 because of pHPT and AC. Two enlarged parathyroid glands were detected by preoperative examinations. We performed total parathyroidectomy and thyroidectomy. After the operation, she showed severe hypocalcemia induced by postsurgical hypoparathyroidism and hungry bone syndrome. This is a rare case of postsurgical severe hypocalcemia associated with pHPT, GD and AC.
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Taeko Uonaga, Kenichi Yoshida, Takanari Harada, Makiko Shimodahira, Yo ...
2012 Volume 51 Issue 14 Pages
1875-1877
Published: 2012
Released on J-STAGE: July 15, 2012
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A 57-year-old woman who had been treated with interferon β-1a (IFNβ-1a) for multiple sclerosis was diagnosed with diabetic ketosis. Her fasting serum C-peptide (F-CPR) was 1.9 ng/mL and her daily urinary C-peptide (U-CPR) was 24.1 μg/day. Her anti-glutamic acid decarboxylase (GAD) antibody was 3.5 U/mL. Seven months later, she was hospitalized with body weight loss and a high level of hemoglobin A1c [11.1% (JDS)]. Her F-CPR and U-CPR were very low (0.1 ng/mL and 8.35 μg/day, respectively), and anti-GAD antibody became distinctly positive (12.4 U/mL). She had HLA-DRB1*04:05, A24, and B54. For these reasons, IFNβ-1a administration was considered a possible cause of type 1 diabetes mellitus in this case.
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Yutaka Fujiwara, Yoshikazu Kawakami, Yoshihiko Shinohara, Kimiyoshi Ic ...
2012 Volume 51 Issue 14 Pages
1879-1884
Published: 2012
Released on J-STAGE: July 15, 2012
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Hereditary xanthinuria is an extremely rare purine metabolism disorder caused by a genetic abnormality in xanthine dehydrogenase. A new case of hereditary xanthinuria type 1 accompanied by bilateral renal calculi was encountered. We performed an allopurinol loading test and diagnosed classical type 1 xanthinuria. Through genetic diagnosis, we identified a mutation site in the xanthine dehydrogenase gene. Genetic analysis revealed a homozygous deletion of cytosine 2,567 in the xanthine dehydrogenase gene, and as a result, a stop codon was formed at position 928. Renal failure caused by the deposition of xanthine crystals is a known complication because xanthine is poorly soluble in water. With high fluid intake and low purine diet, no significant increase in calculi has been observed in this patient for 2 years.
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Taro Sugase, Tetsu Akimoto, Yoshitaka Iwazu, Tomoyuki Yamazaki, Akihik ...
2012 Volume 51 Issue 14 Pages
1885-1888
Published: 2012
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A large number of renal biopsy studies have shown the concurrent presence of non-diabetic renal disease in diabetics. This report describes one such diabetic female patient with nephrotic syndrome due to minimal change glomerular disease who was successfully treated with prednisolone. Despite the remission of her nephrotic syndrome, she had gradual development of malignant ascites, which was finally interpreted to be linked to primary peritoneal carcinoma. It is necessary to bear in mind that malignancies may not only be the underlying etiology for paraneoplastic glomerular injuries, but also can be an independent pathogenic process, regardless of their nephrotic status during the overall management of the patients with ascites.
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Arthur Turow, Tuck Y Yong, Jie Shen Fok, Jordan YZ Li
2012 Volume 51 Issue 14 Pages
1889-1892
Published: 2012
Released on J-STAGE: July 15, 2012
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Azathioprine hypersensitivity is a clinical syndrome which may manifest from isolated fever and rash to multi-organ failure. This rare condition is usually self-limiting following the discontinuation of azathioprine. Therefore, it is important to maintain a high index of clinical suspicion for hypersensitivity reactions with azathioprine therapy. We report a case of azathioprine hypersensitivity in a 69-year-old woman who developed cardiogenic shock and Sweet's syndrome following the initiation of azathioprine for her underlying autoantibodies to neutrophil cytoplasmic antigens (ANCA) associated microscopic polyangiitis.
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Kazunobu Tachibana, Toru Arai, Tomoko Kagawa, Shojiro Minomo, Masanori ...
2012 Volume 51 Issue 14 Pages
1893-1897
Published: 2012
Released on J-STAGE: July 15, 2012
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Sarcoidosis is a systemic granulomatous disease of unknown etiology with characteristic pulmonary lesions, which are often distributed in the upper lung fields. We describe a unique case of sarcoidosis with lower lung field-dominant reticular shadows. Three years after the diagnosis of sarcoidosis based on histologic findings of the mediastinal lymph nodes and transbronchial lung biopsy specimens, the patient developed acute respiratory failure and died. The autopsy showed usual interstitial pneumonia (UIP), with honeycombing and superimposed diffuse alveolar damage of the lungs. The findings suggest that the patient had both sarcoidosis and UIP, and that the UIP later progressed to acute exacerbation.
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Bing Wu, Guang-ju Zhao, Huan Liang, Zhong-qiu Lu, Qiao-meng Qiu, Ying- ...
2012 Volume 51 Issue 14 Pages
1899-1902
Published: 2012
Released on J-STAGE: July 15, 2012
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Anticoagulant therapy is the mainstay in the management of venous thromboembolism. Nevertheless, the situation is entirely different in the patients with submassive or massive pulmonary embolism (PE) and cardiac arrest, and the diagnosis and therapy strategy for such conditions are lacking. This patient, who presented with a cardiac arrest event after varicose vein surgery, was diagnosed as acute pulmonary embolism. She survived after administration of 50 mg recombinant tissue plasminogen activator (rt-PA) for over half an hour, along with continued anticoagulant therapy. Unfortunately, gastrointestinal and cerebral hemorrhaging occurred during the process.
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Takuya Kakuta, Hirokuni Hirata, Sayo Soda, Taichi Shiobara, Mineaki Wa ...
2012 Volume 51 Issue 14 Pages
1903-1907
Published: 2012
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Riluzole has recently been proven as the first effective drug for the treatment of amyotrophic lateral sclerosis (ALS). We report two rare cases of lung injury caused by riluzole therapy in patients with ALS. Chest radiographs showed bilateral lower lobe, dorsal-dominant ground glass opacity, and/or consolidation. A drug lymphocyte stimulation test (DLST) of peripheral blood or bronchoalveolar lavage cells was positive for riluzole. Histopathological examination of lung biopsy specimens revealed lung injury without fungoid granuloma, vasculitis, or diffuse alveolar damage. To the best of our knowledge, this is the first report of riluzole-induced lung injury with positive DLST results.
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Ryo Sato, Hidenori Ichiyasu, Sho Saeki, Shinya Sakata, Ji-ichirou Sasa ...
2012 Volume 51 Issue 14 Pages
1909-1912
Published: 2012
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Non-small cell lung cancer was metastasized at the septal side of right atrium in 59-year-old woman who had undergone surgery for lung cancer 11 years ago. The cardiac metastasis was found by whole-body 18F-fluoro-deoxy-glucose positron emission tomography/computed tomography (FDG-PET/CT), and cytologically confirmed by myocardial aspiration biopsy with right heart catheterization. The patient was treated with 4 cycles of carboplatin/pemetrexed followed by maintenance therapy with pemetrexed. The metastatic cardiac tumor shrank, and the atrioventricular (AV) block in ECG was improved. In this case, FDG-PET and chemotherapy were valuable for diagnosis and treatment of cardiac metastasis from non-small cell lung cancer.
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Toshihisa Sugita, Masashi Nakajima, Daisuke Arai, Kohichiro Kuwabara, ...
2012 Volume 51 Issue 14 Pages
1913-1915
Published: 2012
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We report the case of a 58-year-old woman who presented with acutely developed coma characterized by electroencephalographic triphasic waves (TWs) in the absence of metabolic derangement. The patient's coma and TWs were promptly resolved after the administration of glucocorticoids, and thereafter isolated ACTH deficiency was diagnosed. Isolated ACTH deficiency may present with glucocorticoid-responsive acute encephalopathy without hypoglycemia, hyponatremia, or systemic hypotension. Electroencephalographic TWs or bursts of slow waves may be a clue to the diagnosis of this rare condition in patients with coma of unknown origin.
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Haruo Nishijima, Masahiko Tomiyama, Chieko Suzuki, Tomoya Kon, Yukihis ...
2012 Volume 51 Issue 14 Pages
1917-1921
Published: 2012
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Amyotrophic lateral sclerosis (ALS) with demyelinating polyneuropathy is a rare condition. We describe two ALS patients with demyelinating neuropathy. Immunomodulatory therapies brought slight symptomatic benefits to the patients, but the treatments could not halt the progression of ALS. Chance coincidence of the two diseases is unlikely in view of the low prevalence. ALS, mainly consisting of progressive axonal degeneration, might show temporal demyelinating features of peripheral nerves both electrophysiologically and pathologically. The pathomechanism for the demyelination in ALS remains to be elucidated.
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Yoshihiro Kobashi, Keiji Mouri, Yasushi Obase, Shigeki Kato, Mikio Oka
2012 Volume 51 Issue 14 Pages
1923-1926
Published: 2012
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A 63-year-old man with a past history of resection of pulmonary adenocarcinoma and COPD visited our hospital because of fever, cough and purulent sputum. Chest CT showed an infiltration shadow with multiple bullae in the right lung. There was a slight elevation of the inflammatory response. We established a definitive diagnosis by frequent isolation of
Mycobacterium kyorinense on a sputum culture test of acid-fast bacilli. Clarithromycin and levofloxacin were administered after identification of
M. kyorinense using a 16S rRNA gene sequence. Subsequently his symptoms improved following combined therapy with clarithromycin and levofloxacin.
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Yu Kurahara, Kazunobu Tachibana, Kenji Tezuka, Shigeki Shimizu, Masano ...
2012 Volume 51 Issue 14 Pages
1927-1930
Published: 2012
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A 28-year-old woman was referred to our hospital for treatment of tuberculous lymphadenitis, after presenting with fever, left cervical lymphadenopathy, and a positive interferon-gamma release assay (QuantiFERON
®-TB Gold In-Tube; QFT) result. Surprisingly, biopsy specimens of the cervical lymph nodes showed necrotic lesions with prominent nuclear debris and a proliferation of histiocytes, consistent with Kikuchi-Fujimoto disease (KFD). A diagnosis was made of KFD complicated by latent tuberculosis infection (LTBI), and all symptoms had resolved completely two months post-diagnosis. KFD may be misdiagnosed as tuberculous lymphadenitis, and antibiotics unnecessarily prescribed. Careful attention should therefore be paid when diagnosing cervical lymphadenopathy.
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Kengo Maeda, Ryo Idehara
2012 Volume 51 Issue 14 Pages
1931-1933
Published: 2012
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Since the worldwide spread of the novel influenza type A virus in 2009, trivalent vaccines against H1N1 (pandemic) 09 and seasonal influenza have been used. We describe a 33-year-old woman who presented with hypoesthesia below the Th7 level fifteen days after vaccination without any preceding infection. Cerebrospinal fluid showed an increased level of myelin basic protein and positive oligoclonal IgG bands. Magnetic resonance imaging revealed disseminated lesions in the brain and thoracic cord. Steroid therapy improved her symptoms. She was diagnosed as having acute disseminated encephalomyelitis (ADEM) possibly related to the vaccination. As a potential adverse effect of the influenza vaccine, in addition to Guillain-Barré syndrome, ADEM should also be recognized.
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Nozomu Kaneko, Tatsuya Kawasaki, Hidehisa Boku, Tadaaki Kamitani
2012 Volume 51 Issue 14 Pages
1935-1936
Published: 2012
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Syncope is common in clinical practice, but the cause is often difficult to diagnose. We report a 75-year-old man who was referred to the emergency department because of syncope after an urgent sensation of urinating during jogging. He was finally diagnosed as having a giant bladder diverticulum due to prostatic hyperplasia accompanied by neurally mediated syncope. Excessive urinary retention is a possible cause of not only giant bladder diverticula but also syncope due to vagal enhancement.
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Chieko Sakai, Tatsuya Kawasaki, Tomoko Sakaguchi, Tadaaki Kamitani
2012 Volume 51 Issue 14 Pages
1937
Published: 2012
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Katsura Soma, Masao Takahashi, Tomohiko Sato, Ryozo Nagai
2012 Volume 51 Issue 14 Pages
1939
Published: 2012
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Tomohide Yoshino, Hideki Hayashi, Ichiro Nakae, Minoru Horie
2012 Volume 51 Issue 14 Pages
1941
Published: 2012
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Mingli Sun, Ye Li MD, Xiaoyan Sun, Dianbo Cao
2012 Volume 51 Issue 14 Pages
1943-1944
Published: 2012
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Masaki Ikeuchi, Masatoshi Sekiya, Yoshitoshi Urabe
2012 Volume 51 Issue 14 Pages
1945-1946
Published: 2012
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Supplementary material
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Takayuki Jujo, Seiichiro Sakao, Takashi Oide, Koichiro Tatsumi
2012 Volume 51 Issue 14 Pages
1947-1948
Published: 2012
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Yu Yamamoto, Sayaka Yamamoto, Shigehiro Kuroki
2012 Volume 51 Issue 14 Pages
1949
Published: 2012
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Ken-ya Murata, Shinji Imae, Hideto Miwa, Tomoyoshi Kondo
2012 Volume 51 Issue 14 Pages
1951-1952
Published: 2012
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Kengo Maeda, Ryo Idehara, Tomoyuki Shiraishi
2012 Volume 51 Issue 14 Pages
1953-1954
Published: 2012
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