Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
51 巻, 17 号
選択された号の論文の47件中1~47を表示しています
EDITORIAL
ORIGINAL ARTICLES
  • Shujiro Inoue, Masao Takemoto, Akiko Chishaki, Tomomi Ide, Mari Nishiz ...
    2012 年 51 巻 17 号 p. 2263-2270
    発行日: 2012年
    公開日: 2012/09/01
    ジャーナル オープンアクセス
    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.
  • Yuji Nishizaki, Shinichiro Yamagami, Hikaru Suzuki, Yusuke Joki, Shuuh ...
    2012 年 51 巻 17 号 p. 2271-2276
    発行日: 2012年
    公開日: 2012/09/01
    ジャーナル オープンアクセス
    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.
  • Toshiyuki Nagai, Shun Kohsaka, Mitsushige Murata, Shigeo Okuda, Toshih ...
    2012 年 51 巻 17 号 p. 2277-2283
    発行日: 2012年
    公開日: 2012/09/01
    ジャーナル オープンアクセス
    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.
  • Tetsuya Tagami, Yuko Yambe, Tsuyoshi Tanaka, Takashi Tanaka, Atsushi O ...
    2012 年 51 巻 17 号 p. 2285-2290
    発行日: 2012年
    公開日: 2012/09/01
    ジャーナル オープンアクセス
    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.
  • Chikara Yoshimura, Toru Oga, Kazuo Chin, Misa Takegami, Ken-ichi Takah ...
    2012 年 51 巻 17 号 p. 2291-2297
    発行日: 2012年
    公開日: 2012/09/01
    ジャーナル オープンアクセス
    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.
  • Zhao Huang, Yu-sheng Chen, Zi-li Yang, Ji-yun Liu
    2012 年 51 巻 17 号 p. 2299-2305
    発行日: 2012年
    公開日: 2012/09/01
    ジャーナル オープンアクセス
    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.
  • Kensuke Shiga, Yukiko Tsuji, Chihiro Fujii, Yu-ichi Noto, Masanori Nak ...
    2012 年 51 巻 17 号 p. 2307-2312
    発行日: 2012年
    公開日: 2012/09/01
    ジャーナル オープンアクセス
    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.
  • Yirong Fang, Zhaohui Huang, Chunyu Tu, Lijie Zhang, Dongqing Ye, Bao-P ...
    2012 年 51 巻 17 号 p. 2313-2320
    発行日: 2012年
    公開日: 2012/09/01
    ジャーナル オープンアクセス
    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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