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Masashi Mizuno, Yasuhiro Suzuki, Keisuke Nonaka, Yumi Sei, Shoichi Mar ...
2013 Volume 52 Issue 11 Pages
1177-1181
Published: 2013
Released on J-STAGE: June 01, 2013
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A 46-year-old man on peritoneal dialysis (PD) was hospitalized due to suspicious PD-related peritonitis. Because the patient's abdominal pain was unimproved by conventional antibiotics and multiple bacteria were identified in a smear-sample of PD fluid, endogenous peritonitis was suspected. Perforated appendicitis was finally diagnosed under exploratory laparotomy. In this patient, perforated appendicitis was difficult to diagnose due to the attenuated clinical symptoms and inconclusive results of abdominal computed tomography (CT), even though the positive predictive value of CT is >95% in non-PD patients. Quickly deciding to perform exploratory laparotomy in patients suspected of having endogenous peritonitis is thus important, even when the origin has not been clarified.
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Tomonori Ozeki, Naotaka Ogasawara, Shinya Izawa, Mari Mizuno, Kenichir ...
2013 Volume 52 Issue 11 Pages
1183-1187
Published: 2013
Released on J-STAGE: June 01, 2013
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A 63-year-old woman was admitted with symptoms of watery diarrhea and generalized edema lasting for five months. She had been administered 15 mg/day of lansoprazole. Laboratory findings revealed severe hypoproteinemia with normal liver, renal, thyroid and adrenal functions and no proteinuria. Colonoscopy revealed edematous mucosa, minor diminished vascular transparency and apparent longitudinal linear lacerations. The histopathological findings were compatible with a diagnosis of collagenous colitis (CC). Protein leakage from the colon was identified on
99mTc-human serum albumin scintigraphy. The results indicated CC associated with protein-losing enteropathy. Discontinuing lansoprazole ameliorated the watery diarrhea and generalized edema, increased the serum albumin level and improved the hypoproteinemia.
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Akinori Sato, Masaomi Chinushi, Daisuke Izumi, Hiroshi Furushima, Tohr ...
2013 Volume 52 Issue 11 Pages
1189-1193
Published: 2013
Released on J-STAGE: June 01, 2013
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In two patients treated with cardiac resynchronization therapy (CRT), left ventricular (LV) pacing failure occurred due to ring conductor fractures of the bipolar LV lead (co-radial model). CRT was resumed by pacing between the tip conductor of the LV lead and the coil conductor of the right ventricular lead. However, shortly thereafter, subsequent fracture of the tip conductor developed, and implantation of a new LV lead was required. When one of the bipolar conductors of a co-radial designed LV lead fractures, reimplantation of a new LV lead is a better therapeutic option (than changing the LV pacing mode) in order to reliably continue CRT treatment.
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Akihito Tanaka, Masaki Sakakibara, Koji Okada, Yasushi Jinno, Hideki I ...
2013 Volume 52 Issue 11 Pages
1195-1198
Published: 2013
Released on J-STAGE: June 01, 2013
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Coronary subclavian steal syndrome is an unusual cause of myocardial ischemia, secondary to a reversed blood flow in patients with patent internal thoracic artery coronary bypass grafts. The causes of coronary subclavian steal are either ipsilateral subclavian artery stenosis or upper extremity arteriovenous hemodialysis fistula formation or both. This report involves a 68-year-old woman with left vertebral artery occlusion who developed severe coronary steal in the absence of vertebral subclavian steal due to left subclavian artery stenosis and an arteriovenous hemodialysis graft.
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Hisato Tatsuoka, Shojiro Inano, Yoshiyuki Hamamoto, Yuki Takahashi, Ju ...
2013 Volume 52 Issue 11 Pages
1199-1202
Published: 2013
Released on J-STAGE: June 01, 2013
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We herein report three cases of gonadotroph adenoma in men (36-72 years of age) presenting with visual impairment and suprasellar masses measuring approximately 20 to 30 mm in diameter. Endocrinological examinations were normal, except for slightly increased follicle stimulating hormone (FSH) levels in two cases. Based on the tentative diagnosis of non-functioning pituitary adenoma, transsphenoidal surgery was performed, which revealed that the tumors consisted of FSH- and LH-positive cells. As gonadotroph adenoma is very common among patients with clinically silent pituitary adenoma, it should be diagnosed using pathological examinations.
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Yutaka Yoshii, Yugo Kaneko, Mina Gochi, Zenya Saito, Tsugumi Samejima, ...
2013 Volume 52 Issue 11 Pages
1203-1205
Published: 2013
Released on J-STAGE: June 01, 2013
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A patient with a past history of renal cell carcinoma (RCC) presented to us with an exudative pleural effusion. Because pleural effusion cytology was inconclusive, we performed medical thoracoscopy under local anesthesia. Multiple white tumors measuring approximately 2 cm in diameter were observed on the parietal pleura. Metastatic carcinoma from RCC was diagnosed histologically. Although malignant effusions are rare in cases of RCC metastasis, clinicians should be aware of this possibility. When pleural effusion cytology is inconclusive in a patient with a past history of RCC, medical thoracoscopy can be useful for making the diagnosis of pleural metastasis.
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Jeong-Won Lee, Woo-Jin Kim, Chan-Woo Park, Hyun-Wook Kang, Hee-Jung Ba ...
2013 Volume 52 Issue 11 Pages
1207-1210
Published: 2013
Released on J-STAGE: June 01, 2013
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Endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) is a useful and safe diagnostic test. We herein report a case of endotracheal granuloma formation that occurred after EBUS-TBNA in a 73-year-old woman. The patient was admitted due to coughing and dyspnea after 70 days of antituberculous therapy for mediastinal lymphadenitis. Computed tomography revealed decreases in the size of the lymph nodes with a new mass protruding into the tracheal lumen. The mass originated from the right paratracheal area, which was a previous puncture site. This case suggests that clinicians should pay attention to complications because tuberculosis can produce new granulomas via the sinus tract after EBUS-TBNA.
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Gang Hou, Wei Wang, Ya-bin Zhao, Xin-ming Su, Qiu-yue Wang, Zhen-hua L ...
2013 Volume 52 Issue 11 Pages
1211-1215
Published: 2013
Released on J-STAGE: June 01, 2013
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Sarcoidosis is a multisystemic granulomatous disease of unknown etiology. Pleural effusion is rare in patients with sarcoidosis, occurring in 0.7% to 20% of cumulative series. Bloody pleural effusion is even more rare. We herein report two cases of sarcoidosis with bloody pleural effusion and discuss the clinical manifestations, diagnostic procedures and treatment of these cases. Sarcoidosis should be included in the differential diagnosis when bloody pleural effusions are detected. An increased level of lymphocytes and an increased ratio of CD4+/CD8+ lymphocytes in bronchoalveolar lavage fluid (BALF) are helpful for making a diagnosis of sarcoidosis. Medical thoracoscopy is helpful for determining the definitive diagnosis. Corticosteroids are an effective treatment; however, the dose should be individualized according to the treatment response.
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Aiko Kato, Yuichiro Ono, Yosuke Nagahata, Nobuhiko Yamauchi, Sumie Tab ...
2013 Volume 52 Issue 11 Pages
1217-1221
Published: 2013
Released on J-STAGE: June 01, 2013
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Although fatal pulmonary complications frequently occur during the course of acute leukemia, a minor proportion of the complications are due to leukemia itself. Infections, drug reactions and concomitant medical conditions are the major causes of respiratory distress in leukemic patients. We treated four patients with acute myeloid leukemia complicated by leukemic cell lysis pneumopathy (LCLP). All of the patients had leukemia of monocytoid origin and their respiratory function deteriorated soon after chemotherapy initiation. Although two of the patients required mechanical ventilation, all four improved after continued chemotherapy. Our experience indicates that, in cases of LCLP, chemotherapy should be continued with maximal respiratory support.
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Yasuyuki Arai, Tadakazu Kondo, Toshiyuki Kitano, Kouhei Yamashita, Nor ...
2013 Volume 52 Issue 11 Pages
1223-1226
Published: 2013
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Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is an important electrolyte abnormality that can occur following allogeneic stem cell transplantation. We herein report the case of a 20-year-old man who developed SIADH three weeks after undergoing cord blood transplantation. Tacrolimus administration was suspected to be a cause of the disorder. In addition to restricting water intake and administering hypertonic sodium, the tacrolimus dosage was reduced, resulting in alleviation of SIADH. Therefore, tacrolimus should be recognized as an important, albeit rare, cause of drug-induced SIADH, even in patients with tacrolimus blood concentrations within the normal range. We believe that dose reduction, not discontinuation, is an effective strategy.
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Qingchao Zeng, Yan Yuan, Pei Li, Tong Chen
2013 Volume 52 Issue 11 Pages
1227-1233
Published: 2013
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Spontaneous remission (SR) in patients with acute myeloid leukemia (AML) is rare. We herein present two such cases. The first case was of AML-M2 accompanied by a bone marrow cytogenetic analysis revealing 46, XY, t(8;21)(q22,q22). The second case was of isolated cutaneous myeloid sarcoma (MS) that progressed to AML within seven months. Both of the patients had symptoms of infection and anemia and were therefore treated with antibiotics and transfusions. The SR lasted for two months and one month, respectively. Currently, the mechanisms underlying SR remain ambiguous. Possible underlying mechanisms with a review of the related literature are discussed.
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Shuji Ueda, Masahiko Kubo, Noriko Matsuura, Hitomi Matsunaga, Seiko Ka ...
2013 Volume 52 Issue 11 Pages
1235-1238
Published: 2013
Released on J-STAGE: June 01, 2013
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Plasma cell leukemia (PCL) is an aggressive variant of multiple myeloma characterized by a high level of plasma cells circulating in the peripheral blood. The prognosis of PCL patients treated with conventional chemotherapy remains poor. Some reports have suggested that both bortezomib and lenalidomide are effective in treating PCL. We herein report a case of primary PCL in which the patient achieved stringent complete remission after receiving combination chemotherapy with reduced-dose bortezomib, lenalidomide and dexamethasone (VRd). This regimen was very effective, and no severe adverse events were observed. A reduced-dose VRd regimen can be considered in PCL patients.
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Kiyoshi Okazuka, Masayoshi Masuko, Yuji Matsuo, Shukuko Miyakoshi, Tom ...
2013 Volume 52 Issue 11 Pages
1239-1242
Published: 2013
Released on J-STAGE: June 01, 2013
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A 51-year-old man was admitted due to a severe bleeding tendency. After he was diagnosed with immune thrombocytopenia (ITP), several therapies, including steroids, steroid pulse, vincristine and rituximab, were administered; however, the patient's bleeding symptoms were not sufficiently controllable with these treatments. Subsequently, a diffuse alveolar hemorrhage was observed. Treatment with a thrombopoietin receptor agonist, romiplostim, was initiated to prevent lethal hemorrhaging, although the efficacy of thrombopoietic receptor agonists in such emergency situations has not been elucidated. The initiation of romiplostim achieved prompt remission in platelets. This case suggests that combination therapy with romiplostim, rituximab and vincristine is effective in cases of newly diagnosed severe therapy-resistant ITP.
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Koji Tanaka, Toshiyuki Uehara, Masahiro Miyoshi, Fumio Miyashita, Taka ...
2013 Volume 52 Issue 11 Pages
1243-1247
Published: 2013
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We herein report two autopsy cases of severe cardioembolic stroke with oscillating thrombi in the bilateral extracranial internal carotid arteries (ICAs) demonstrated on carotid ultrasonography performed on admission. An autopsy study of Case 1 conducted on the third hospital day revealed no thrombi, while that of Case 2 conducted on the 42nd hospital day revealed red thrombi in the extracranial ICAs. Our postmortem studies confirm that oscillating thrombi may be seen in the region of blood stasis caused by occlusion of the distal portion of the ICA, thus reflecting a pre-state of thrombus formation.
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Yoshitaka Yamaguchi, Manabu Wada, Haruko Tanji, Katsuro Kurokawa, Toru ...
2013 Volume 52 Issue 11 Pages
1249-1253
Published: 2013
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A 67-year-old man receiving antithrombotic therapy developed rapidly progressive amnesia. T2-weighted images of brain MRI revealed hyperintense lesions in the bilateral thalami accompanied by microbleeds. Antithyroglobulin antibodies and autoantibodies against the N-terminal of α-enolase (NAE) were identified in the patient's serum; therefore, Hashimoto's encephalopathy (HE) was suspected. Although the patient's radiological findings improved following steroid therapy, his symptoms did not improve, possibly due to increased thalamic microbleeds. Because anti-NAE antibodies are possibly associated with vasculitis, HE accompanied by anti-NAE antibodies may be exacerbated by microbleeds in patients receiving antithrombotic therapy.
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Fatih Yildiz, Didem Arslan Tas, Arbil Açikalin, Tugba Karakas, ...
2013 Volume 52 Issue 11 Pages
1255-1257
Published: 2013
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Pigmented purpuric dermatosis (PPD) is a group of chronic disorders characterized by the extravasation of erythrocytes and marked hemosiderin deposits in the dermis. Schamberg disease is a subtype of pigmented purpuric dermatosis in which nonpalpable purpura is prominent on the lower extremities. No cases of primary antiphospholipid syndrome and pigmented purpuric dermatosis have so far been reported in the literature. We herein report a case of pigmented purpuric dermatosis associated with primary antiphospholipid syndrome.
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Masahiko Setoguchi, Eri Iwasawa, Yuji Hashimoto, Mitsuaki Isobe
2013 Volume 52 Issue 11 Pages
1259-1262
Published: 2013
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An 85-year-old woman complaining of nausea was admitted to our hospital after being found to have complete atrioventricular block. We diagnosed the patient with infective endocarditis after observing vegetation on transesophageal echocardiography (TEE) and detecting
Pseudomonas aeruginosa in a blood culture. The patient had no history of intravenous drug use, instrumentation or valvular disease. Although sensitive antibiotics were administered intravenously, the second TEE performed on the 10th day demonstrated increased vegetation. The patient developed septic shock and died on the 14th day. To our knowledge, this is the first report of infective endocarditis caused by community-acquired
Pseudomonas aeruginosa in Japan.
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Memduh Oruc, Ahmet Engin Atay, Pervin Karabulut, Semir Pasa, Ahmet Elb ...
2013 Volume 52 Issue 11 Pages
1263-1265
Published: 2013
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Hemangiomas are benign vascular tumors that usually involve the liver, skin, eyes and central nervous system. Hemangioma of the bone is unusual and is generally observed in the vertebrae or skull while hemangioma of the costae is extremely rare. Hemangioma of the rib and chest wall tuberculosis may be misdiagnosed as chest wall tumors. We herein report a case of hemangioma of the rib with a tuberculosis infection of the pleura.
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Hideki Ono, Takako Tasaki, Jin Tanahashi, Kazunari Murakami
2013 Volume 52 Issue 11 Pages
1267-1268
Published: 2013
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Masaki Watanabe, Tadayuki Kou, Hiroshi Kawamoto, Shujiro Yazumi
2013 Volume 52 Issue 11 Pages
1269
Published: 2013
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Keiko Komoto, Sangkil Ha-Kawa, Noboru Tanigawa, Toshihiko Kinoshita
2013 Volume 52 Issue 11 Pages
1271-1272
Published: 2013
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Benoît Lattuca, Florence Leclercq, Antoine Micheau, Franç ...
2013 Volume 52 Issue 11 Pages
1273
Published: 2013
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Kazuki Ito, Shoudou Takegoshi
2013 Volume 52 Issue 11 Pages
1275-1276
Published: 2013
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Daisuke Taniyama, Keisuke Miyamoto, Shuko Mashimo, Fumio Sakamaki
2013 Volume 52 Issue 11 Pages
1277
Published: 2013
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Alessandro Fabbri, Michela Grazzini, Franco Vannucci, Antonio Sanna
2013 Volume 52 Issue 11 Pages
1279
Published: 2013
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Akiko Kawasaki, Keisuke Suzuki, Hidehiro Takekawa, Koichi Hirata
2013 Volume 52 Issue 11 Pages
1281-1282
Published: 2013
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Hirofumi Goto, Tatsuya Tanaka, Nobuaki Momozaki
2013 Volume 52 Issue 11 Pages
1283-1284
Published: 2013
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Domenico Plantone, Guido Primiano, Serenella Servidei
2013 Volume 52 Issue 11 Pages
1285
Published: 2013
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Teruhiko Sekiguchi, Yoichiro Nishida, Akira Inaba, Shigeo Toyota
2013 Volume 52 Issue 11 Pages
1287-1288
Published: 2013
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