Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
Volume 51, Issue 7
Displaying 1-27 of 27 articles from this issue
  • Naoya Mitsuba, Hiroki Teragawa, Takaki Hata, Kenji Nishioka, Yuichi Fu ...
    2012 Volume 51 Issue 7 Pages 691-698
    Published: 2012
    Released on J-STAGE: April 01, 2012
    Objective To investigate the clinical factors, including intravascular ultrasound (IVUS) findings, associated with percutaneous coronary intervention (PCI)-related periprocedural myonecrosis (PM) in patients with stable coronary artery disease (CAD).
    Methods The study included 46 patients (mean age 65±2 y, 37 men) with stable CAD who underwent elective PCI using IVUS and a Doppler flow guidewire. In addition to routine IVUS measurements, the presence of deep echo attenuation (DEA) without calcification was assessed. The sum of all high-intensity transient signals (HITS) after a balloon deflation procedure was calculated using a Doppler flow guidewire. PM was defined as an elevation in troponin T to >0.03 ng/mL 24-hour after PCI. Patients were divided into 2 groups on the basis of the presence or absence of PM.
    Results PM was identified in 17 patients (37%). Estimated glomerular filtration ratio was lower in the PM group (p=0.021). Target vessel distribution was different between the groups (p=0.004). Positive remodeling and DEA, as observed on IVUS, were more common in the PM group (p=0.03 and p<0.0001, respectively). The total number of HITS was higher in the PM group (p=0.003). Logistic regression analysis demonstrated that the presence of DEA (p=0.003) was the sole factor associated with the occurrence of PM.
    Conclusion These results demonstrated that DEA is an important factor associated with PM in patients who underwent an elective PCI. Therefore, IVUS to determine the presence of DEA should be performed before PCI.
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  • Yusuke Kabeya, Kiyoe Kato, Masuomi Tomita, Takeshi Katsuki, Yoichi Oik ...
    2012 Volume 51 Issue 7 Pages 699-705
    Published: 2012
    Released on J-STAGE: April 01, 2012
    Objective The associations of insulin resistance and glycemic control with the risk of kidney stones were explored.
    Methods Generally healthy Japanese (n=2,171) who visited Saiseikai Central Hospital (Tokyo, Japan) for a health check were included in a cross-sectional study. We calculated odds ratios (OR) of having kidney stones in terms of four measures: fasting serum insulin, homeostasis model assessment of insulin resistance (HOMA-IR), fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c), adjusting for possible risk factors for kidney stones.
    Results Fasting serum insulin and HOMA-IR were non-significantly associated with the risk of kidney stones, whereas FPG and HbA1c were significantly associated. Compared with those with an FPG of <100 mg/dL, the ORs in those with an FPG of 100 to <126 mg/dL and ≥126 mg/dL were 1.38 (95% confidence interval [CI] =0.95-2.00) and 1.83 (95% CI =1.09-3.06) (p for trend =0.016). In relation to those with an HbA1c of <5.5%, the ORs in those with an HbA1c of 5.5 to <6.0%, 6.0% to <6.5% and ≥6.5% were 1.16 (95% CI =0.76-1.79), 1.25 (95% CI =0.70-2.23) and 1.98 (95% CI =1.11-3.52), respectively (p for trend =0.027). The significant associations between glycemic control measures and the risk of kidney stones were preserved even after the adjustment for factors related to insulin resistance.
    Conclusion Glycemic control could be an independent risk factor for kidney stones.
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  • Hidekazu Suzuki, Tomonori Hirashima, Masashi Kobayashi, Norio Okamoto, ...
    2012 Volume 51 Issue 7 Pages 707-710
    Published: 2012
    Released on J-STAGE: April 01, 2012
    Objective The incidence of malignant pleural mesothelioma (MPM) in Japan is predicted to increase over the next few decades. Prognostic factors remain unclear although several studies have reported this disease. In this study, we examined the prognostic factors of MPM from single institution practice data and tested the scoring systems of past reports.
    Methods We retrospectively obtained clinical data from the medical records of patients who were diagnosed with MPM from 1991 to 2010. The European Organization for Research and Treatment of Cancer prognostic score (EPS) was calculated.
    Results We surveyed the records of 68 patients. Univariate analysis showed that significant prognostic factors were histological type, stage, performance status (PS), chemotherapy, and lactate dehydrogenase (LD). Multivariate analysis identified stage, PS and LD as independent prognostic factors. Low-risk group (EPS ≤1.27) survival was significantly better than that of the high-risk group (EPS >1.27) (17.0 months vs. 8.0 months; p=0.002).
    Conclusion Stage, PS and LD were demonstrated to be independent prognostic factors. An EPS >1.27 was still considered a poor prognosis indicator in the practice data of MPM.
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  • Tsuyoshi Matsumura, Toshio Saito, Harutoshi Fujimura, Susumu Shinno, S ...
    2012 Volume 51 Issue 7 Pages 711-716
    Published: 2012
    Released on J-STAGE: April 01, 2012
    Objective Respiratory muscle weakness causes alveolar hypoventilation and reduced lung compliance in neuromuscular disorders. Lung inflation is important to prevent secondary pulmonary complications however respiratory and laryngeal dysfunction often hamper lung inflation. There is a need for a convenient and low-cost device that enables effective lung inflation. We tested a lung inflation training method using a positive end-expiratory pressure (PEEP) valve.
    Methods Vital capacity (VC), maximum insufflation capacity (MIC) and peak cough flow (PCF) as well as PEEP lung inflation capacity (PIC) were assessed in 93 neuromuscular patients. Consecutive PIC training was done for 4 months in six tracheostomized Duchenne muscular dystrophy (DMD) patients and PIC was assessed before and after training.
    Results PIC training was practicable in all participants and no serious adverse events were detected. PIC was significantly higher than VC or MIC in all disorders, although MIC was higher than VC in DMD only. Patients with dysphagia showed lower MIC and PCF compared with non dysphagic patients. PIC was as low as 345±77 mL in tracheostomized DMD patients; however consecutive training increased it up to 619±205 mL.
    Conclusion The PEEP valve enabled effective lung inflation regardless of laryngeal function. Consecutive training can improve lung condition even in advanced cases. Early introduction of PIC training could be effective at preventing respiratory complications in patients with neuromuscular disorders.
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  • Zhenyu Liang, Haijin Zhao, Yanhua Lv, Rui Li, Hangming Dong, Laiyu Liu ...
    2012 Volume 51 Issue 7 Pages 717-722
    Published: 2012
    Released on J-STAGE: April 01, 2012
    Background and Aim Eosinophilic phenotype, sputum eosinophil count ≥3%, of asthma is a valuable clinical parameter. However, measurement of sputum inflammatory cells is time-consuming and requires specialized personnel. A simpler surrogate, such as peripheral eosinophil count, would be beneficial. The aim of this study was to assess the value of peripheral eosinophil count for predicting the eosinophilic phenotype of adult asthmatics.
    Materials and Methods This retrospective study was conducted in 192 adult asthmatics. Sputum and venous blood were collected at the same visit and analyzed for cell differential. Receiver-operating characteristic (ROC) curve analysis was used to assess the relationship between eosinophilic phenotype and peripheral eosinophil count.
    Results Peripheral eosinophil count, derived from the ROC curve, of more than 210 cells/mm3 yielded 67.7% sensitivity and 66.2% specificity [area under the curve (AUC)=0.698, p=0.0001] for identifying the eosinophilic phenotype in the total patients. Multiple regression analysis revealed that steroid treatment and atopy significantly influenced the peripheral eosinophil count. Within the steroid-naïve subgroup, a peripheral eosinophil count of >190 cells/mm3 yielded 76.3% sensitivity and 67.4% specificity (AUC=0.730, p<0.0001) for identifying eosinophilic phenotype, while in the steroid treated subgroup, the AUC was 0.554 (p=0.4985). Within the steroid-naïve non-atopic subgroup, a peripheral eosinophil count of >190 cells/mm3 yielded 73.1% sensitivity and 79.3% specificity (AUC=0.809, p=0.0001) for identifying the eosinophilic phenotype, while in the steroid-naïve atopic subgroup, the AUC was 0.588 (p=0.2723).
    Conclusion Peripheral eosinophil count is able to identify the presence of eosinophilic phenotype in steroid-naïve non-atopic adult asthmatics with moderate accuracy.
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