Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
Volume 51 , Issue 17
Showing 1-47 articles out of 47 articles from the selected issue
EDITORIAL
ORIGINAL ARTICLES
  • Shujiro Inoue, Masao Takemoto, Akiko Chishaki, Tomomi Ide, Mari Nishiz ...
    2012 Volume 51 Issue 17 Pages 2263-2270
    Published: 2012
    Released: September 01, 2012
    JOURNALS OPEN ACCESS
    Background Systemic thermal therapy (STT) has been associated with beneficial effects in patients with chronic heart failure (CHF). The fact, however, that it requires a dedicated as well as spacious facility and trained personnel makes it difficult to practice in the daily care of patients with CHF.
    Objective The aim of this study was to determine whether the leg thermal therapy (LTT) has a positive impact similar to that of STT in patients with CHF.
    Methods and Results Twenty patients with CHF (57±17 years old, left ventricular ejection fraction=30±10%) received LTT (45°C) for 20 minutes. Immediately after the treatment, the core temperature had increased (+0.3±0.3°C) (p<0.01). While the LTT had no significant effects on the heart rate, systolic arterial pressure, and diastolic blood pressure, it increased the cardiac output (mixed venous oxygen saturation; +2±3%) and decrease the pulmonary capillary wedge pressure (-2±2 mmHg). The LTT significantly improved the flow-mediated vasodilatation (FMD) from 4.8±2.6 to 7.1±3.6%, the antioxidative markers, thiol from 4.0±0.7 to 4.5±0.9 μmoL/g, and the marker of oxidative deoxyribonucleic acid (DNA) damage, urine 8-hydroxy-2'deoxyguanosine (8OHdG) from 100 to 82±3%, respectively (p<0.05). No patient had any adverse effects associated with LTT.
    Conclusion LTT acutely improved FMD, and oxidative stress in patients with CHF. Although the long-term effect of LTT remains to be investigated, its practicality which is comparable to that of STT would make it an attractive therapeutic strategy for patients with CHF.
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  • Yuji Nishizaki, Shinichiro Yamagami, Hikaru Suzuki, Yusuke Joki, Shuuh ...
    2012 Volume 51 Issue 17 Pages 2271-2276
    Published: 2012
    Released: September 01, 2012
    JOURNALS OPEN ACCESS
    Objective Red blood cell distribution width (RDW) is a numerical measure of erythrocyte size variation. It has been recently reported to be an independent prognostic marker of heart failure (HF). Previous studies on RDW were mostly designed for middle-aged and elderly patients (60-79 years old), therefore, there is no established limit for super-elderly patients (≥80 years old). The purpose of this study was to evaluate RDW as an effective tool to detect fatal HF in super-elderly patients.
    Methods The medical records and death certificates of 160 consecutive patients admitted to the Department of Cardiology in Juntendo Tokyo Koto Geriatric Medical Center and who died from June 2002 to October 2010 were reviewed. The causes of death were reviewed, and the factors, including RDW, that might have been related to the fatal HF were evaluated using multivariate logistic regression analysis.
    Results HF was the major cause of death [52 patients (32.5%), 29 females, age 84.0±7.5 years], followed by pneumonia (18.8%, 30/160), and acute myocardial infarction (16.3%, 26/160). The most common cause of HF was atrial fibrillation (36.6%, 19/52), followed by hypertensive heart disease (19.2%, 10/52) and valvular disorders (17.3%, 9/52). The multivariate logistic regression analysis found that a high RDW (≥16.5%) was an independent factor related to fatal HF (OR 2.36, 95% CI 1.10, 5.04, p=0.03).
    Conclusion HF was the major cause of death, and RDW ≥16.5 was significantly associated with fatal HF in super-elderly patients.
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  • Toshiyuki Nagai, Shun Kohsaka, Mitsushige Murata, Shigeo Okuda, Toshih ...
    2012 Volume 51 Issue 17 Pages 2277-2283
    Published: 2012
    Released: September 01, 2012
    JOURNALS OPEN ACCESS
    Objective We sought to determine the value of electrocardiographic right ventricular hypertrophy (ECG-RVH) in pulmonary hypertension (PH) patients with right ventricular systolic dysfunction defined by cardiac magnetic resonance (CMR-RVSD).
    Patients A total of 31 consecutive patients with PH with a mean pulmonary arterial pressure of >25 mmHg underwent both ECG and CMR studies. Patients were divided into 2 groups according to the presence of RVSD, defined as a RV ejection fraction <35%. Logistic regression modeling was performed to define the association between ECG-RVH and CMR-RVSD.
    Results About half of the patients had RVSD (n=15 ; 48%). The R to S wave ratio (p=0.01) or incidence of qR pattern (p=0.002) in lead V1 was significantly greater in patients with PH complicated by RVSD than in those without RVSD. These 2 patterns were significant predictors of RVSD [odds ratio (OR), 19.3 for qR; OR, 14.0 for R/S>1] and when each of these ECG findings was assigned with a point proportional to OR (score of 2 for qR in lead V1 and score of 1 for R/S>1 in lead V1), the incidence of RVSD increased by the total ECG score.
    Conclusion The combination of ECG-RVH findings, especially in lead V1, predicts the presence of RVSD defined by CMR. ECG might be a useful tool for estimating the presence of RVSD in patients with PH.
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  • Tetsuya Tagami, Yuko Yambe, Tsuyoshi Tanaka, Takashi Tanaka, Atsushi O ...
    2012 Volume 51 Issue 17 Pages 2285-2290
    Published: 2012
    Released: September 01, 2012
    JOURNALS OPEN ACCESS
    Objective β-adrenergic antagonists (β-blockers) are often used to attenuate the hyperadrenergic symptoms of Graves' disease (GD), including palpitation. Although β-blockers reduce the heart rate, cardiac output and oxygen consumption, no firm evidence exists regarding the effects of combined therapy with β-blockers and anti-thyroid drugs. The objective is to elucidate the effects of β-blockers on anti-thyroid drug therapy in GD.
    Methods Patients newly diagnosed with mild GD were randomly assigned to receive methimazole with or without β-blockers in a prospective multi-center survey. The heart rate and thyroid function were measured and the quality of life was assessed using original and SF-36 questionnaires at 0 and 4 weeks.
    Results A total of 28 patients were enrolled in the study. Fourteen patients (one man, 13 women) were randomly assigned to the group treated with β-blockers and 14 patients (one man, 13 women) were randomly assigned to the group not treated with β-blockers. Although no significant differences in the improvement of thyroid function were observed between the two groups, the heart rates improved more significantly in the group treated with β-blockers. Specific symptoms, such as easy fatigability and shortness of breath, also improved more significantly with the β-blocker treatment. In addition, 'physical functioning' assessed with the SF-36 questionnaires significantly improved only in the group treated with β-blockers.
    Conclusion Although β-blockers may not reinforce the effects of anti-thyroid drugs on thyroid function, at least during the course of one month, they are effective in reducing heart rates and ameliorating specific symptoms in patients with mild GD.
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  • Chikara Yoshimura, Toru Oga, Kazuo Chin, Misa Takegami, Ken-ichi Takah ...
    2012 Volume 51 Issue 17 Pages 2291-2297
    Published: 2012
    Released: September 01, 2012
    JOURNALS OPEN ACCESS
    Objective Decreased lung function as assessed by forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) is shown to be associated with cardiovascular morbidity and mortality. Although the underlying mechanisms for this association remain unknown, metabolic syndrome and obstructive sleep apnea (OSA) may have a role. We analyzed the relationships between metabolic syndrome and OSA in a cross-sectional health survey of middle-aged male employees.
    Methods In this secondary analysis, we re-analyzed the relationships of lung function determined by spirometry with metabolic syndrome and OSA based on the respiratory disturbance index (RDI) with a type 3 portable monitor.
    Results We analyzed 273 subjects. Independent of age, body mass index (BMI) and smoking, quartiles for lower FVC and FEV1 were associated with a higher risk of metabolic syndrome compared with quartiles for the highest FVC and FEV1, respectively. A similar trend was observed regarding the risk associated with waist circumference, and in FVC cases, dyslipidemia. The risk of hyperglycemia was significantly higher in quartiles for the second lowest FVC and FEV1 than in quartiles for the highest FVC and FEV1, respectively. A significant trend for an increase in RDI was observed in accordance with quartiles for lower FVC, but not FEV1.
    Conclusion There was a significant relationship between lung function impairment and metabolic syndrome through mainly abdominal obesity, partially through hyperglycemia, and also through dyslipidemia, but only with respect to restrictive lung function. Restrictive lung function was also related to OSA. This epidemiologic evidence may indicate underlying mechanisms between decreased lung function and cardiovascular risk.
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  • Zhao Huang, Yu-sheng Chen, Zi-li Yang, Ji-yun Liu
    2012 Volume 51 Issue 17 Pages 2299-2305
    Published: 2012
    Released: September 01, 2012
    JOURNALS OPEN ACCESS
    Objective To compare the efficacy and safety of sedation with dexmedetomidine vs. midazolam for patients with acute cardiogenic pulmonary edema and hypoxemia during the treatment of non-invasive ventilation (NIV).
    Methods The intensive care unit (ICU) patients treated in our hospital between March 2008 and August 2011 who had acute pulmonary edema and hyoxemia in NIV failure due to patient refusal to continue the NIV sessions (due to discomfort) were enrolled in this study. The patients were divided into two groups by the random numerical table method. They were treated with either midazolam (29 cases) or dexmedetomidine (33 cases). The patients were sedated (Ramsay scale 2-3) by a continuous perfusion of midazolam or dexmedetomidine during the NIV session. Cardiorespiratory and ventilatory parameters, the results of the blood gas analysis, and adverse events were prospectively recorded. The main outcome measure was the percentage of endotracheal intubation during NIV. Secondary endpoints included the duration of non-invasive mechanical ventilation, length of ICU stay, and adverse events.
    Results In both groups of patients, the expected sedative scores were obtained. The cardiorespiratory symptoms and signs (oxygenation index, pH value, and respiratory rate) were significantly improved in both groups. In the dexmedetomidine-treated group, the patients had a further decreased percentage of failure of NIV requiring endotracheal intubation (ETI) and a more prolonged mean time to ETI (p=0.042, p=0.024). Furthermore, when compared with the group treated with midazolam, the overall duration of mechanical ventilation and the duration of ICU hospitalization in the group treated with dexmedetomidine were markedly decreased, and weaning from mechanical ventilation was easier (p=0.010, p=0.042). Despite the fact that more dexmedetomidine-treated patients developed bradycardia (18.2% vs. 0, p=0.016), no patients required an intervention or interruption of study drug infusion. Conversely, the incidence of respiratory infections and vomiting was lower in the dexmedetomidine-treated patients (p=0.026, p=0.010).
    Conclusion Dexmedetomidine led to a more desired level of awaking sedation, shortened the duration of mechanical ventilation and the length of the ICU stay, and further reduced the prevalence of nosocomial infection for NIV sedation in patients with acute cardiogenic pulmonary edema. It appears to provide several advantages and safe control compared with the γ-amino butyric acid (GABA) agonist midazolam.
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  • Kensuke Shiga, Yukiko Tsuji, Chihiro Fujii, Yu-ichi Noto, Masanori Nak ...
    2012 Volume 51 Issue 17 Pages 2307-2312
    Published: 2012
    Released: September 01, 2012
    JOURNALS OPEN ACCESS
    Objective A significant number of patients with Fisher syndrome (FS) exhibit sensory symptoms in addition to the classical triad of opthalmoplegia, ataxia and areflexia. Previous studies have shown the amplitudes of sensory nerve action potentials (SNAPs) to decrease in patients with FS, thus implying the presence of an axonal pathology in the sensory nerves.
    Methods We included ten consecutive patients with FS who were divided into the following two groups: those with hypesthesia (group H) and those without hypesthesia (group NS). The parameters obtained from nerve conduction studies (amplitudes of compound muscle action potentials, motor conduction velocities, amplitudes/duration of SNAPs and sensory conduction velocities) were retrospectively compared between the two groups. In addition, follow-up sensory nerve conduction studies were conducted in one representative patient from each group.
    Results Of the 10 patients with FS, four (40%) showed hypesthesia and eight (80%) showed distal paresthesia. The amplitudes of the SNAPs of both the median and sural nerves were lower in group H than in group NS. Moreover, the duration of the sural SNAPs was longer in group H than in group NS. Desynchronization of SNAPs in the acute phase was observed during follow-up in both patients who underwent follow-up studies.
    Conclusion The prolonged duration of SNAPs in group H and the desynchronization of SNAPs in the two patients who underwent follow-up studies suggest the presence of a concomitant demyelinating process in the sensory nerves.
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  • Yirong Fang, Zhaohui Huang, Chunyu Tu, Lijie Zhang, Dongqing Ye, Bao-P ...
    2012 Volume 51 Issue 17 Pages 2313-2320
    Published: 2012
    Released: September 01, 2012
    JOURNALS OPEN ACCESS
    Objective Scrub typhus is an important febrile disease in Asia, and antibiotics have been used to treat this disease. The purpose of this study was to generate large-scale evidence of the efficacy of different antibiotic regimens for treating scrub typhus using a meta-analysis.
    Methods PubMed, Elsevier ScienceDirect, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), and Wanfang (Chinese) were searched to identify relevant articles. The data from eligible citations were extracted by two reviewers. All analyses were performed using the Cochrane Collaboration Review Manager 4.2 and Stata 10.0 software programs.
    Results We conducted a meta-analysis of 17 separate studies that evaluated the efficacy of treatment with the different antibiotic regimens for scrub typhus. The median time (h) to clearance of fever in the azithromycin-treated group was longer than that in the chloramphenicol-treated group (weighted mean difference [WMD] = 12.66, 95% confidence interval [CI]: 2.26,23.06). Adverse events were 2.95 (95%CI: 1.32, 6.61) times more likely to occur in the azithromycin-treated group than in the chloramphenicol-treated group. The clearance time (days) for the main symptoms (including fever, headache, rash and lymphadenectasis) in the doxycycline-treated group was shorter than that in the chloramphenicol-treated group (WMD = -0.4, 95%CI: -0.53, -0.26) in five trials. Adverse drug events occurred significantly less frequently in the azithromycin-treated group than in the doxycycline-treated group (relative risk [RR] = 0.47, 95%CI: 0.31,0.71).
    Conclusion Doxycycline was found to act more quickly, but more adverse drug events occur when using this regimen compared to azithromycin and chloramphenicol.
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CASE REPORTS
  • Hidetsugu Yamagishi, Taku Sakamoto, Takahisa Matsuda, Takeshi Nakajima ...
    2012 Volume 51 Issue 17 Pages 2321-2324
    Published: 2012
    Released: September 01, 2012
    JOURNALS OPEN ACCESS
    We herein present a case of IIc-like metastatic lung cancer that was detected early. A 65-year-old man presented with diarrhea and difficulty walking. Colonoscopy demonstrated a depressed lesion in the descending colon. However, the appearance of the lesion by endoscopy with a magnifying objective was not compatible with early colon cancer. Therefore, we performed diagnostic endoscopic mucosal resection to allow for an examination of the whole lesion. A histological examination demonstrated lung cancer metastasis to the colon. Only 1.6% of lung cancers metastasize to the large intestine, and metastatic colorectal cancer is not usually detected at an early stage. In the present case, however, endoscopy and a histological examination revealed alterations in the mucosal configuration of the lesion, which were unusual for early colon cancer.
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  • Yukiko Kanno, Atsushi Takahashi, Kazumichi Abe, Toru Takagi, Ken Okai, ...
    2012 Volume 51 Issue 17 Pages 2325-2328
    Published: 2012
    Released: September 01, 2012
    JOURNALS OPEN ACCESS
    We report the case of a 41-year-old woman with hepatocellular carcinoma (HCC). She received living donor liver transplantation (LDLT) from her husband for HCC at 36 years of age. She had few risk factors for HCC recurrence, such as elevated alpha-fetoprotein (AFP), protein induced by vitamin K absence (PIVKA) II, vascular invasion, and number, size of tumors. However, recurrent tumors were found in the graft at 54 months after LDLT. Although we examined the sex chromosomes of the HCC by fluorescence in situ hybridization (FISH) methods, the origin of the HCC was unclear. This is a very rare case of recurrent HCC appearing more than 4 years after LDLT in the absence of risk factors for recurrence.
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  • Takaaki Murakami, Hiroki Nishikawa, Yorimitsu Koshikawa, Yoshihiro Oka ...
    2012 Volume 51 Issue 17 Pages 2329-2335
    Published: 2012
    Released: September 01, 2012
    JOURNALS OPEN ACCESS
    We herein present a rare case of myocardial metastases from intrahepatic cholangiocarcinoma. The patient was a 68-year-old man diagnosed with stage IVb intrahepatic cholangiocarcinoma. Growing low-density nodules at the cardiac interventricular septum and the left lateral wall were found on contrast enhanced computed tomography (CECT). He died and an autopsy was performed. Intrahepatic cholangiocarcinoma was found to have metastasized to the myocardium, and these myocardial metastases conformed to the low-density nodules detected on CECT. A hilar nodule in the lung was revealed to be lung squamous cell carcinoma. This was a rare case of intrahepatic cholangiocarcinoma with myocardial metastases and lung squamous cell carcinoma.
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  • Makoto Sano, Masao Saotome, Tsuyoshi Urushida, Hideki Katoh, Hiroshi S ...
    2012 Volume 51 Issue 17 Pages 2337-2340
    Published: 2012
    Released: September 01, 2012
    JOURNALS OPEN ACCESS
    We present a case of pulmonary arterial hypertension (PAH), which is potentially related to treatment with dasatinib (Sprycel®). A 61-year-old woman, who had been treated with dasatinib for 27 months for chronic myeloid leukemia (CML), visited our hospital complaining of dyspnea. In right heart catheterization, her mean pulmonary arterial pressure was 35 mmHg. After other possible etiologies to cause PAH were excluded, the patient was diagnosed as a dasatinib-related PAH. As notified by U.S. Food and Drug Administration (FDA) in October 2011, we recommend routine cardiopulmonary evaluation before and during treatment with dasatinib in CML patients in terms of the adverse effects of PAH.
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  • Hiroaki Kawano, Tomayoshi Hayashi, Takako Minami, Yuji Koide, Kiyoyuki ...
    2012 Volume 51 Issue 17 Pages 2341-2345
    Published: 2012
    Released: September 01, 2012
    JOURNALS OPEN ACCESS
    A 51-year-old woman was admitted to our hospital with heart failure due to aortic regurgitation. Examination showed severe aortic regurgitation mainly due to cleft-like deformity of the right coronary cusp and single coronary artery. Aortic valve replacement was performed, and the deformity was seen in all aortic cusps. Histological study showed elongation of the leaflets by myofibrotic and fibrotic hyperplasia without calcification and inflammation in the aortic valve. This deformity likely arose from an acquired modification of a congenitally malformed aortic valve.
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  • Yoichi Imori, Hajime Fujimoto, Shigeo Hanada, Hironori Uruga, Hisashi ...
    2012 Volume 51 Issue 17 Pages 2347-2349
    Published: 2012
    Released: September 01, 2012
    JOURNALS OPEN ACCESS
    We herein report the case of an idiopathic aneurysm of the accessory hemiazygos vein diagnosed by contrast-enhanced computed tomography (CT) and angiography. The patient was asymptomatic, and a posterior mediastinal mass was incidentally found on CT. Because endoscopic ultrasonography showed no thrombus formation in the aneurysm, the patient was therefore managed conservatively.
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  • Tomohiro Nakamura, Mitsunari Matsumoto, Takeshi Ishida, Yuji Shimada
    2012 Volume 51 Issue 17 Pages 2351-2353
    Published: 2012
    Released: September 01, 2012
    JOURNALS OPEN ACCESS
    We report an adult case of internal mammary arteriovenous fistula which was found to have a continuous murmur. The fistula was clearly demonstrated by multi-detector row computed tomography and selective digital subtraction angiography, and was successfully occluded by transcatheter embolization.
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  • Yuji Okura, Takashi Kawasaki, Tohru Hiura, Hiroshi Seki, Hirofumi Sait ...
    2012 Volume 51 Issue 17 Pages 2355-2359
    Published: 2012
    Released: September 01, 2012
    JOURNALS OPEN ACCESS
    We herein report the histopathology of a rare case of an idiopathic internal mammary artery aneurysm in a 61-year-old asymptomatic woman. Chest radiography during an annual medical check-up incidentally revealed the aneurysm, which was initially mistaken for a mediastinal tumor. Given that a rupture of the aneurysm could have been life-threatening, it was removed surgically, and found to possess a paper-thin arterial wall with cystic medial degeneration.
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  • Hee Jin Kim, Ho-Su Kim, Jong Ryeal Hahm, Jung Hwa Jung, Soo Kyoung Kim ...
    2012 Volume 51 Issue 17 Pages 2361-2363
    Published: 2012
    Released: September 01, 2012
    JOURNALS OPEN ACCESS
    A 23-year-old pregnant woman had a stillbirth at 30 weeks gestation due to abrupt diabetic ketoacidosis. The patient had a normal HbA1c, severe hyperglycemia, negative islet cell autoantibodies, and very low insulin secretion capacity. The viral markers associated with fulminant type 1 diabetes were negative. The patient's human leukocyte antigen genotypes were DRB1*04:06 and DQB1*03:01/05:02, not common subtypes for fulminant type 1 diabetes. This is the first Vietnamese patient with fulminant type 1 diabetes mellitus.
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  • Shugo Sasaki, Tetsuyuki Yasuda, Hideaki Kaneto, Michio Otsuki, Yukiko ...
    2012 Volume 51 Issue 17 Pages 2365-2370
    Published: 2012
    Released: September 01, 2012
    JOURNALS OPEN ACCESS
    We herein report the case of a 41-year-old male patient with an incidentally identified large adrenal ganglioneuroma (GN). His endocrine examinations were normal except for one episode of elevated urinary dopamine and noradrenaline levels. Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) showed a large solid tumor with calcifications and a slightly lobular edge in the right adrenal gland. We performed open tumor excision and diagnosed it as adrenal ganglioneuroma. Adrenal GN is a rare benign tumor, and its hormonal activity and imaging characteristics are occasionally very similar to those of other adrenal tumors. Therefore, it needs careful evaluation by endocrine examinations and multiple imaging procedures to rule out other types of tumors.
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  • Su Yin Lau, Tuck Yean Yong
    2012 Volume 51 Issue 17 Pages 2371-2374
    Published: 2012
    Released: September 01, 2012
    JOURNALS OPEN ACCESS
    Patients with acute adrenal insufficiency may have musculoskeletal symptoms including flexion contractures, myopathy and hyperkalaemic neuromyopathy. However, the association between rhabdomyolysis and acute adrenal insufficiency is extremely rare and has only been reported infrequently in the literature. Hyponatraemia is often present in association with acute adrenal insufficiency complicated by rhabdomyolysis. We herein report the case of a patient with acute primary adrenal insufficiency and severe hyponatraemia complicated by rhabdomyolysis and acute kidney injury.
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  • Sunao Yamamoto, Yosuke Okada, Hiroko Mori, Seiji Fukumoto, Yoshiya Tan ...
    2012 Volume 51 Issue 17 Pages 2375-2378
    Published: 2012
    Released: September 01, 2012
    JOURNALS OPEN ACCESS
    A 44-year-old woman with iron deficiency anemia was on a continuous course of intravenous saccharated ferric oxide (SFO). She came to our hospital because of right hip joint pain. She was found to have hypophosphatemia caused by impaired phosphorus resorption and her fibroblast growth factor 23 (FGF-23) levels were elevated. Therefore, she was diagnosed with FGF-23-related osteomalacia due to SFO administration. Discontinuation of the SFO treatment rapidly improved the impaired phosphorus resorption and also normalized the blood levels of phosphorus and FGF-23. During the treatment with SFO, it is important to regularly measure the blood levels of phosphorus in order to prevent the occurrence of osteomalacia.
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  • Yuko Harada, Hisanao Akiyama, Tatsuji Yoshimoto, Yasuko Urao, Munekazu ...
    2012 Volume 51 Issue 17 Pages 2379-2383
    Published: 2012
    Released: September 01, 2012
    JOURNALS OPEN ACCESS
    Thyroid storm is a rare disorder with a sudden onset, rapid progression and high mortality. We experienced a case of thyroid storm which had a devastating course, including multiple organ failure (MOF), severe hypoglycemia, disseminated intravascular coagulation (DIC), and stroke. It was difficult to make a diagnosis of thyroid storm in the present patient, because she did not have a history of thyroid disease and her serum FT3 level was normal. Clinicians should be aware that thyroid storm can occur even when there is an almost normal level of thyroid hormones, and that intensive anticoagulation is required for patients with atrial fibrillation to prevent stroke after thyroid storm.
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  • Yi Fang, Jun Hou, Fengqing Cai, Xiaoqiang Ding, Hong Liu
    2012 Volume 51 Issue 17 Pages 2385-2391
    Published: 2012
    Released: September 01, 2012
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    IgG4-related systemic disease (IgG4-RSD) is an autoimmune disease that includes a wide variety of lesions. IgG4-RSD is characterized by high levels of serum IgG4, abundant levels of IgG4-positive plasma cells and T-lymphocyte infiltration in various organs. Tubulointerstitial nephritis (TIN) is a major finding when the kidneys are involved and is effectively treated with corticosteroid therapy. We herein describe two cases of IgG4-related TIN. Such cases have rarely been reported in China.
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  • Ayano Ito, Naoto Miura, Yukihiro Kimura, Sayaka Maeda, Keisuke Suzuki, ...
    2012 Volume 51 Issue 17 Pages 2393-2397
    Published: 2012
    Released: September 01, 2012
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    A 68-year-old woman showed rapidly progressive glomerulonephritis based on the fact that she had 1+ proteinuria (1.1 g/day), a 3+ occult blood reaction, blood urea nitrogen of 32.4 mg/dL, serum creatinine of 2.96 mg/dL, and myeloperoxidase (MPO)-anti-neutrophil cytoplasmic antibodies (ANCA) at 52 ELISA Unit (normal range: below 10). A renal biopsy demonstrated a bubbling appearance associated with cellular crescent formation with segmental necrosis. Immunofluorescence studies showed granular IgG3λ deposition along the basement membrane and in the mesangial area. This is the first English-language case report describing MPO-ANCA positive crescentic glomerulonephritis in a patient demonstrating monoclonal immunoglobulin deposition disease with mainly membranous features.
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  • Naoki Kubo, Taishi Harada, Satoshi Anai, Kohei Otsubo, Yasuto Yoneshim ...
    2012 Volume 51 Issue 17 Pages 2399-2401
    Published: 2012
    Released: September 01, 2012
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    A 26-year-old man with unresectable inflammatory myofibroblastic tumor (IMT) presented with multiple metastases in the thoracic vertebra and lymph nodes as detected by positron emission tomography (PET) received chemotherapy with carboplatin plus paclitaxel. After three cycles of chemotherapy, fluorine-18-fluorodeoxyglucose (FDG)-PET/CT revealed tumor regression and significant reduction of FDG uptake in all lesions. The patient received six cycles of chemotherapy without any severe adverse event, and there was no sign of disease progression for seven months. This regimen is well tolerated and may be considered the treatment of choice for unresectable IMT.
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  • Shinpei Kato, Hiroki Umezawa, Toshiaki Yano, Takashi Ogasawara, Norio ...
    2012 Volume 51 Issue 17 Pages 2403-2406
    Published: 2012
    Released: September 01, 2012
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    Chyloptysis is a very rare clinical finding. We describe a 44-year-old man who presented with cough and milky-white sputum. Fiberoptic bronchoscopy revealed white sputum, which originated from the right B6 bronchus. The finding of elevated triglyceride levels in his sputum led to the diagnosis of chyloptysis. He had a surgical history of ligation of the thoracic duct for idiopathic chylopericarditis 7 years-previously. He also suffered from postoperative bilateral empyema. Since then, his pleural cavity has been adhered bilaterally. It is thought that his abnormal postoperative lymphatic flow caused the chyloptysis.
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  • Yousuke Wada, Tomonobu Koizumi, Toshiki Yokoyama, Kazuhisa Urushihata, ...
    2012 Volume 51 Issue 17 Pages 2407-2410
    Published: 2012
    Released: September 01, 2012
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    Although rare, gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. The asynchronous occurrence of other malignancies in patients with GIST during the clinical course is relatively common. However, the synchronous coexistence of GIST and lung cancer has only rarely been reported. We experienced a case of coincidental primary lung adenocarcinoma and intestinal GIST. The present case is not only of interest due to the rare coincidence of GIST and lung cancer, but also because there was an epidermal growth factor receptor gene mutation in the lung cancer and a c-kit mutation in the GIST.
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  • Makoto Hayashi, Hiromi Takayasu, Mami Tada, Yohei Yamazaki, Hidetsugu ...
    2012 Volume 51 Issue 17 Pages 2411-2415
    Published: 2012
    Released: September 01, 2012
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    A 74-year-old Japanese man with myelodysplastic syndrome (MDS) received chemotherapy with azacitidine. From the second day after starting the administration, he complained of fever, cough and shortness of breath. Chest roentgenography and computed tomography showed consolidations and ground-glass opacities. His symptoms grew from worse to life-threatening. We diagnosed him with azacitidine-induced pneumonitis and began administering corticosteroids. Thereafter, his symptoms and radiographic abnormalities improved. Azacitidine is a hypomethylating agent that improves the survival of MDS patients. Although this drug is commonly well tolerated and rarely causes severe lung injury, it is important to consider the potentially serious adverse effects of azacitidine-induced pneumonitis.
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  • Junichiro Yuda, Riko Honma, Gen Tamura, Eijiro Omoto
    2012 Volume 51 Issue 17 Pages 2417-2421
    Published: 2012
    Released: September 01, 2012
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    We report a 67-year-old woman who was diagnosed with hepatic portal venous gas associated with severe graft-versus-host disease (GVHD) of the gastrointestinal tract. The patient received allogenic peripheral blood stem cell transplantation from a haploidentical son against Philadelphia chromosome-positive acute lymphocytic leukemia. The patient developed grade 3 intestinal GVHD on day 90 from the transplantation. On day 149, she presented septic shock and computed tomography (CT) scan revealed hepatic portal venous gas (HPVG); an ileocecal resection was performed immediately. The damage of gastrointestinal mucosa by GVHD resulted in the invasion of gas-producing bacteria. Although HPVG-associated gastrointestinal GVHD is extremely rare, we should pay special attention to this pathogenesis.
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  • Toshihiko Shirafuji, Fumio Kanda, Kenji Sekiguchi, Masatsugu Higuchi, ...
    2012 Volume 51 Issue 17 Pages 2423-2427
    Published: 2012
    Released: September 01, 2012
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    A 63-year-old woman had anti-Hu-associated paraneoplastic encephalomyelitis (anti-Hu syndrome) caused by esophageal small cell carcinoma (SCC). The patient developed bilateral limbic encephalitis, followed by myelitis, brain stem encephalitis, and autonomic failure. Extensive examination demonstrated SCC of the abdominal lymph nodes that was retrospectively diagnosed as metastasis of esophageal SCC on autopsy. The neuropathological findings were characterized by widespread neuronal loss and gliosis in the central nervous system, as well as patchy loss of myelin and axons in the spinal nerve roots with perivascular lymphocytic infiltration. This is the first detailed clinical and neuropathological report of anti-Hu syndrome caused by esophageal SCC.
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  • Akihiko Morita, Masaki Ishihara, Satoshi Kamei, Hiroshi Ishikawa
    2012 Volume 51 Issue 17 Pages 2429-2431
    Published: 2012
    Released: September 01, 2012
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    A 60-year-old woman developed opsoclonus-myoclonus syndrome (OMS) a week after being diagnosed with influenza A infection by a rapid antigen test. She had no loss of consciousness. Opsoclonus, myoclonus, and truncal ataxia were noted. Two weeks after treatment with intravenous immunoglobulin and corticosteroids, her opsoclonus, myoclonus, and truncal ataxia disappeared. No malignant tumors were detected during the 3-year follow-up period. There has been no previous report of postinfectious OMS following confirmed influenza A infection. OMS without a loss of consciousness has been reported to be statistically less common in cases of non-paraneoplastic OMS. This finding was consistent with the present patient's clinical manifestations.
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  • Takanori Takazawa, Ken Ikeda, Kiyoko Murata, Yuji Kawase, Takehisa Hir ...
    2012 Volume 51 Issue 17 Pages 2433-2437
    Published: 2012
    Released: September 01, 2012
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    We herein report a 26-year-old man with Guillain-Barré Syndrome (GBS) coexisting facial nerve palsy (FP) and deafness. He developed deafness, facial weakness, and limb weakness and numbness. Neurological examination showed facial diplegia, bilateral hypoacusia, areflexia and sensorimotor deficits in the distal limbs. The nerve conduction study findings supported the diagnosis of the demyelinating polyneuropathy. An audiogram revealed sensorineural hearing loss of 40-50 dB. Auditory brainstem responses disclosed no elicitation of waves I to IV on both sides. Magnetic resonance imaging depicted abnormal enhancement in bilateral facial and acoustic nerves. Physicians should pay more attention to auditory dysfunction in GBS patients with FP.
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  • Wei-Hsi Chen, Tzu-Hui Li, Lian-Hui Lee, Chih-Cheng Huang
    2012 Volume 51 Issue 17 Pages 2439-2441
    Published: 2012
    Released: September 01, 2012
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    A nummular headache (NH) is a type of primary headache that results from cranial neuralgia without a known cause. We herein report the case of a woman who suffered two episodes of focal headache in the left parietal area with identical characteristics that were compatible with NH. During the recovery phase of the second NH episode, the pain resurged with shingles coinciding with the painful area. The patient's NH subsided in parallel with resolution of the shingles. These findings support a diagnosis of peripheral neuralgia with NH. Latent virus infections, such as Varicella-zoster virus, that frequently cause distal nerve damage in patients with zoster sine herpete may be associated with epicranial neuralgia and NH.
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  • Mari Kitada, Hidekazu Suzuki, Juri Ichihashi, Rino Inada, Katsuichi Mi ...
    2012 Volume 51 Issue 17 Pages 2443-2447
    Published: 2012
    Released: September 01, 2012
    JOURNALS OPEN ACCESS
    Neuromyelitis optica spectrum disorder (NMOSD) is characterized by optic neuritis or transverse myelitis with anti-aquaporin 4 (AQP4) antibodies (1). We herein present the case of a patient with NMOSD who also was affected with peripheral neuropathy. A 58-year-old woman developed gait disturbance and sensory impairment in the lower limbs. She exhibited longitudinally extensive transverse myelitis with anti-AQP4 antibodies. Nerve conduction studies showed demyelinating changes. Laboratory findings showed hepatitis-C virus (HCV) infection. Her peripheral neuropathy improved after immunotherapy. There have been no previous reports of NMO or NMOSD associated with neuropathy. The HCV infection or undetermined humoral factors other than the anti-AQP4 antibodies may have caused her peripheral neuropathy.
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  • Shunsuke Kobayashi, Toshimitsu Momose, Masaki Sakurai, Ichiro Kanazawa
    2012 Volume 51 Issue 17 Pages 2449-2451
    Published: 2012
    Released: September 01, 2012
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    A 70-year-old woman developed marked akinesia after an anoxic event related to bronchiectasia. Magnetic resonance imaging studies revealed lesions in the bilateral globus pallidus and, to a lesser extent, in the putamen. Positron emission tomography studies with 18F-6-fluoro-L-dopa and 11C-N-methylspiperone showed a decreased pre- and post-synaptic uptake in the striatum. Consistent with previous reports, the present case demonstrated the basal ganglia, particularly the globus pallidus, to be selectively susceptible to anoxic insults. Furthermore, a PET study indicated a disrupted presynaptic integrity of the dopaminergic terminals and decreased dopamine D2 receptor binding, which together appear to underlie the pathophysiology of post-anoxic akinesia, at least in the present case.
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  • Takefumi Hitomi, Toru Oga, Tomomasa Tsuboi, Chikara Yoshimura, Takeo K ...
    2012 Volume 51 Issue 17 Pages 2453-2456
    Published: 2012
    Released: September 01, 2012
    JOURNALS OPEN ACCESS
    In patients with obstructive sleep apnea (OSA) and epilepsy, the frequency of generalized spike and wave complexes (GSWCs) usually decreases after the initiation of nasal continuous positive airway pressure (nCPAP) therapy. However, we herein report a patient who had a transient increase in GSWCs following nCPAP treatment. A woman with epilepsy underwent polysomnography, who showed severe OSA and 30 GSWCs during the sleep study. Polysomnography at the introduction nCPAP showed that the GSWCs increased to 94 times during the monitoring period, despite improvement of her OSA. Polysomnography was again performed four months later, and the GSWCs had decreased to 23 times. Physicians should therefore be cautious regarding a possible increase in epileptiform discharges and seizures immediately after the introduction of nCPAP.
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  • Yusuke Hanioka, Keiko Yamagami, Katsunobu Yoshioka, Tomomi Nakamura, M ...
    2012 Volume 51 Issue 17 Pages 2457-2461
    Published: 2012
    Released: September 01, 2012
    JOURNALS OPEN ACCESS
    A case of Churg-Strauss syndrome complicated by chronic symmetrical dacryoadenitis suggestive of Mikulicz's disease is herein presented. A 72-year-old Japanese man, who had been previously diagnosed with asthma, presented with weakness of the left leg and purpura on the lower extremities. A neurological examination showed multiple mononeuropathies and a laboratory examination revealed elevated eosinophil counts, IgE levels and the presence of Myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCAs). Churg-Strauss syndrome was diagnosed, although the patient also exhibited bilateral swelling of the lachrymal glands. Furthermore, elevated serum IgG4 levels, an infiltration of a relatively large number of IgG4-positive plasmacytes in the nasal mucosa and hypocomplementemia were also observed. These findings were consistent with a diagnosis of Mikulicz's disease (MD). Oral prednisolone (30 mg) was administered and the swelling of the lachrymal glands resolved. Churg-Strauss syndrome may be accompanied by Mikulicz's disease (an IgG4-related disease), and common pathogeneses between Churg-Strauss syndrome and IgG4-related disease may exist.
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  • Hiroshi Otera, Go Yamamoto, Kiyofumi Ohkusu, Haruka Kozuki, Kimio Hash ...
    2012 Volume 51 Issue 17 Pages 2463-2467
    Published: 2012
    Released: September 01, 2012
    JOURNALS OPEN ACCESS
    A 62-year-old man presented with general fatigue. He was diagnosed with septic shock and severe pneumonia. The sputum at admission yielded methicillin-sensitive Staphylococcus aureus (MSSA) strain and methicillin-resistant S. aureus (MRSA) strain. Despite antibiotic treatment, he did not improve. A chest computed tomography (CT) revealed multilobar cavity lesions. Only MRSA strain was confirmed at that time. We diagnosed him with necrotizing pneumonia. Despite treatment with vancomycin, his pneumonia worsened and he died. At autopsy, many gram-positive cocci were observed in the lungs. The clinical presentation of our patient was different from typical CA-MRSA-mediated necrotizing pneumonia.
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  • Takeshi Nishijima, Hirohisa Yazaki, Fumihiko Hinoshita, Daisuke Tasato ...
    2012 Volume 51 Issue 17 Pages 2469-2471
    Published: 2012
    Released: September 01, 2012
    JOURNALS OPEN ACCESS
    We describe a case of 68-year-old Japanese man with HIV-1 infection who developed acute kidney injury with prominent tubular dysfunction immediately after starting tenofovir-containing antiretroviral therapy. Antiretroviral therapy was discontinued in two weeks but renal function, as well as tubular function, did not shown full recovery even at a 3-year follow-up examination. Acute tubular necrosis, a rare but well-known side effect of tenofovir, was suspected, but kidney biopsy confirmed interstitial nephritis. It is important to distinguish drug-induced interstitial nephritis from acute tubular necrosis, because early steroid administration can improve renal dysfunction caused by acute interstitial nephritis.
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  • Kei Kunimasa, Tadashi Ishida, Soichiro Kimura, Maki Tanaka, Yuichi Kou ...
    2012 Volume 51 Issue 17 Pages 2473-2478
    Published: 2012
    Released: September 01, 2012
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    This report presents a case of fulminant community-acquired Pseudomonas aeruginosa necrotizing pneumonia in a previously healthy young man, including an analysis of the virulence of the P.aeruginosa isolated from the patient. The patient was successfully treated with intensive care and antibiotic treatment. This study analyzed the pathogenicity of the isolated strain both in vivo (using a mouse pneumonia model) and in vitro (using biofilm production), but could not explain how an otherwise healthy young man developed such severe community-acquired P.aeruginosa pneumonia. Although rare in community-acquired pneumonia, P.aeruginosa infection should be considered in patients with severe rapidly progressive pneumonia.
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  • Ilknur Balta, Guler Vahaboglu, Ayse Anil Karabulut, Fahri Yetisir, Muz ...
    2012 Volume 51 Issue 17 Pages 2479-2481
    Published: 2012
    Released: September 01, 2012
    JOURNALS OPEN ACCESS
    A 46-year-old man complained of ulcerovegetative lesions in the anogenital region, which he had noted one month prior to presentation. The patient had a history of travel to African countries. Therefore, the ulcerovegetative lesions of the patient were suspected to be granuloma inguinale (GI). Calymmatobacterium granulomatis was not observed in the direct examination of scrapings collected from the base of the ulcerovegetative lesion. Instead, a histological examination revealed cutaneous metastasis of mucinous adenocarcinoma of the rectum. Therefore, a diagnosis of GI was eliminated. As the patient did not report his history of rectal cancer and had travelled to African countries, we had primarily focused on the diagnosis of GI.
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