Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
52 巻, 3 号
選択された号の論文の28件中1~28を表示しています
ORIGINAL ARTICLES
  • Eiko Takahashi, Kengo Moriyama, Minoru Yamakado
    2013 年 52 巻 3 号 p. 295-301
    発行日: 2013年
    公開日: 2013/02/01
    ジャーナル オープンアクセス
    電子付録
    Objective The Japan Atherosclerosis Society (JAS) has recommended serum lipid management goals (SLMGs) based on the coronary heart disease (CHD) risk classification included in its 2007 guidelines for the diagnosis and prevention of atherosclerotic cardiovascular disease in the Japanese population (JAS GL 2007). The Japan Society of Ningen Dock created a database of subjects receiving annual health examinations at 21 institutes nationwide. Using this database, we evaluated the efficacy of current treatment for patients with dyslipidemia by identifying risk factors for CHD development, based on the JAS recommendations.
    Methods This multicenter, retrospective study was conducted using data obtained from 21 institutions across Japan. 17,991 adults taking dyslipidemia medications were enrolled. The JAS GL 2007 was used for evaluation. Since the guideline indicated separate goals (secondary prevention for subjects with a prior history of CHD and primary prevention for those with other CHD risk factors), we evaluated the percentages of goals met. The serum low-density lipoprotein cholesterol (LDL-C) levels were calculated using the Friedewald formula. The LDL-C level was measured using a direct homogeneous assay if the triglycerides (TG) level was 400 mg/dL or higher.
    Results The achievement rates of the SLMGs were as follows: LDL-C, 72.3%; high-density lipoprotein cholesterol (HDL-C), 94.6%; and TG, 69.7%.
    Conclusion Our results regarding Japanese patients receiving dyslipidemia treatment for CHD prevention identified insufficient reductions in the levels of LDL-C and TG in those at high risk for CHD and suggest the need for more aggressive lipid-lowering therapy.
  • Shuichi Tsuruoka, Hirayasu Kai, Joichi Usui, Naoki Morito, Chie Saito, ...
    2013 年 52 巻 3 号 p. 303-308
    発行日: 2013年
    公開日: 2013/02/01
    ジャーナル オープンアクセス
    Objective Some angiotensin receptor blockers (ARBs), including irbesartan, increase the peroxisome proliferator-activated receptor (PPAR)-g activity in vitro. The aim of this study was to evaluate the interactions between obesity and the effects of irbesartan on inflammatory cytokines in chronic glomerulonephritis patients without diabetes.
    Methods The anti-inflammatory effects of irbesartan were evaluated in 29 hypertensive chronic glomerulonephritis patients without diabetes in a prospective, single-arm study.
    Results Following treatment with irbesartan for 26 weeks, blood pressure and proteinuria significantly decreased, as previously reported (blood pressure decreased from 142±1/87±1 to 131±1/81±1 mmHg and the urine protein/creatinine ratio decreased from 1,030±143 to 779±121 mg/g Cr). BMI did not significantly change after the study. Among the inflammatory parameters, the concentrations of adiponectin and high-sensitivity C-reactive protein (hsCRP) significantly improved after treatment; however, the changes in the concentrations of interleukin-6 (IL-6), tumor necrosis factor (TNF)-a and leptin did not reach statistical significance. Moreover, the changes in these five parameters following treatment were moderately correlated with the BMI values obtained at the initiation of the study, and the improvements were particularly prominent in those with a BMI greater than 25. Improvements in proteinuria were significantly correlated with increases in the adiponectin concentration, but not with BMI. There was also a moderate correlation between the changes in the adiponectin and insulin concentrations.
    Conclusion Irbesartan improves metabolic parameters in nondiabetic hypertensive chronic glomerulonephritis patients, especially those with a high BMI. Improving the adiponectin concentration may be important for reducing proteinuria.
  • Motonori Kobayashi, Mika Kobayashi, Hiroshi Suwa, Eisuke Matsushima
    2013 年 52 巻 3 号 p. 309-315
    発行日: 2013年
    公開日: 2013/02/01
    ジャーナル オープンアクセス
    Objective The main purpose of this study was to translate the Calgary Sleep Apnea Quality of Life Index (SAQLI) and to evaluate the reliability, validity and responsiveness of the Japanese version of the SAQLI (SAQLI-J).
    Methods Translation of the SAQLI questionnaire into the SAQLI-J questionnaire was performed following the guidelines of cross-cultural adaptation of health-related quality of life (QOL) measures. All patients completed the following questionnaires both at baseline and three months later: the SAQLI-J, the Medical Outcome Survey Short Form (SF-36) and the Epworth Sleepiness Scale (ESS). The SAQLI-J was conducted by an interviewer.
    Patients One hundred and fifteen obstructive sleep apnea hypopnea syndrome (OSAHS) patients were recruited into the present study.
    Results The internal consistency and test-retest reliability of the total SAQLI-J scores (SAQLI-J total) were both excellent. Regarding construct validity, the SAQLI-J was tested by measuring the inter-domain correlation between the SAQLI-J domains and the SF-36 domains. All of the SAQLI-J domains and the SAQLI-J total were found to be moderately to highly correlated with the domains of the SF-36. Moreover, the responsiveness of the SAQLI-J total measured according to the standardized response mean was found to be moderate, and the SAQLI-J was found to be more responsive than the SF-36 for detecting changes in the QOL after continuous positive airway pressure treatment.
    Conclusion The results suggest that the SAQLI-J is a valid, reliable and responsive health-related QOL questionnaire for use in Japanese OSAHS patients.
  • Takashi Ishiguro, Noboru Takayanagi, Shozaburo Yamaguchi, Hideaki Yama ...
    2013 年 52 巻 3 号 p. 317-324
    発行日: 2013年
    公開日: 2013/02/01
    ジャーナル オープンアクセス
    Objective Community-acquired pneumonia (CAP) remains a major cause of death. No studies have reported the use of rapid influenza diagnostic tests (RIDT) for the etiological diagnosis, and the factors contributing to severity and mortality have not yet been fully investigated. The aim of this study was to review the etiologies of CAP using RIDT and to identify risk factors related to the severity and mortality of the disease.
    Methods This retrospective study assessed these factors in hospitalized patients, with special emphasis on microbial etiology.
    Results A total of 1,032 patients aged 63.9±18.3 years were studied, 66.2% of whom were men. Microbial identification was obtained in 57.0% of the cases. The most frequent causative microbial agents were Streptococcus pneumoniae, Mycoplasma pneumoniae and the influenza virus, and the second most frequent pathogens in the patients with severe CAP and the non-survivors were S. pneumoniae and the influenza virus. Age (≥65 years), chronic obstructive pulmonary disease, congestive heart failure, diabetes mellitus, dementia and Legionella spp. infection and polymicrobial infection were each found to be independent factors related to severity in the multivariate analysis, whereas "unidentified pathogen" was found to be an independent factor for non-severe CAP. Age (≥65 years), chronic pulmonary aspergillosis, post-lung cancer surgery and severe CAP were found to be independent factors for non-survival according to a multivariate analysis.
    Conclusion In addition to S. pneumoniae, the influenza virus was a frequent cause of CAP overall and a frequent causative pathogen in both severe cases of CAP and non-survivors. Legionella spp. infection and polymicrobial infection were found to be an independent factor for the severity of CAP along with advanced age and certain comorbidities. An advanced age, certain respiratory comorbidities and severe CAP were found to be important independent factors for the mortality of CAP.
  • Hiroya Utsumi, Yasuyuki Okuma, Osamu Kano, Yutaka Suzuki, Mutsumi Iiji ...
    2013 年 52 巻 3 号 p. 325-332
    発行日: 2013年
    公開日: 2013/02/01
    ジャーナル オープンアクセス
    電子付録
    Objective The long-term use of levodopa to treat Parkinson's disease (PD) is often limited by the development of motor complications (e.g. levodopa-induced dyskinesia, LID). We hypothesized that a non-ergot dopamine agonist with strong affinity for D3 dopamine receptors (pramipexole) may improve LID in patients taking an ergot D1/D2 dopamine agonist.
    Methods Patients with PD and LID being treated with levodopa in addition to an ergot dopamine agonist were randomized to either a group in which pramipexole was added to current medications or a group in which the ergot dopamine agonist was switched to pramipexole. Dyskinesia was evaluated using Core Assessment Program for Surgical Interventional Therapies scores. The Unified Parkinson's Disease Rating Scale scores, Modified Hoehn and Yahr stages (at 'on' time), Parkinson's Disease Questionnaire-39 scores and Clinical Global Impression-Improvement scores were also used for evaluation.
    Results At 24 weeks, pramipexole alleviated LID with more efficiency in the switch group.
    Conclusion Pramipexole may be a therapeutic option for treating LID because its effects on D3 dopamine receptors may balance the D1 dopamine receptor supersensitivity associated with LID.
  • Hirotaka Nakanishi, Haruki Koike, Koji Matsuo, Fumiaki Tanaka, Tomoko ...
    2013 年 52 巻 3 号 p. 333-337
    発行日: 2013年
    公開日: 2013/02/01
    ジャーナル オープンアクセス
    Objective The incidence of sporadic inclusion body myositis (sIBM) in the Japanese population has increased, and some researchers have suggested that race and genetic background may influence the clinical features of the disease. The aim of this study was to clarify the demographic features of Japanese patients with sIBM.
    Methods We retrospectively evaluated the demographic features of consecutive patients who were referred to our institution between 1995 and 2011 for diagnostic muscle biopsies and who subsequently were diagnosed to have sIBM.
    Results Seventy-three patients comprising 54 men and 19 women received a diagnosis of sIBM during the study period. The patients were divided into two groups based on the date of diagnosis (before and including 2002, and after 2002). The annual number of patients who received a diagnosis of sIBM increased significantly from 3.6±1.6 (mean ± SD) before and including 2002 to 4.9±3.1 (mean ± SD) after 2002 (p<0.05), whereas the annual number of patients who received a diagnosis of polymyositis (PM) or dermatomyositis (DM) remained consistent from 1995 to 2011. The ratio of PM and DM to sIBM was 7.6 during the period from 1995 to 2002 and 5.5 during the period from 2003 to 2011. However, the age-adjusted annual number of patients newly diagnosed with sIBM did not increase significantly after 2002.
    Conclusion The number of Japanese patients with sIBM appears to have increased in recent years; however, the characteristics of the patients have not changed. Considering the increased size of the elderly population, prolonged lifespans could explain the demographic movement of sIBM in Japan.
  • Sukran Erten, Orhan Kucuksahin, Ali Sahin, Alpaslan Altunoglu, Mesut A ...
    2013 年 52 巻 3 号 p. 339-344
    発行日: 2013年
    公開日: 2013/02/01
    ジャーナル オープンアクセス
    Objective The aim of the present study was to evaluate the plasma vitamin D (vit D) levels and their association with the disease activity in patients with ankylosing spondylitis (AS) and undifferentiated spondyloarthritis (uSpA) compared with healthy populations.
    Methods This study included 161 spondyloarthritis patients (113 uSpA patients and 48 AS patients) attending our rheumatology out-patient clinic, along with 92 controls.
    Results The plasma vit D levels were 18 μg/L (8-38) in the AS group, 20 μg/L (4-92.3) in the uSpA group and 24.3 μg/L (7.2-76.8) in the control group. The plasma vit D levels of the AS patients were significantly lower than those of the patients in the control group (p=0.004). The men in the AS group had significanly lower vit D levels than those in the control group (p=0.005). On the other hand, the women in the uSpA group had significanly lower vit D levels than those in the control group (p=0.011). The vit D levels were inversely related to both erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in the AS patients (p=0.002, R=-0.428; p<0.001, R=-0.592, respectively). This correlation was not demonstrated in the uSpA patients. The vit D levels were not found to correlate with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) levels in either the AS or uSpA patients.
    Conclusion 25-hydroxy-vit D deficiency is frequently observed in patients with SpAs. In this study, vit D deficiency was much more prominent in the male AS patients. On the other hand, among women, the uSpA patients exhibited much more prominent vit D deficiency than the control group subjects. The acute phase response may inversely affect the vit D levels in AS patients.
  • Seiji Koga, Satoshi Ikeda, Tomohiko Yasunaga, Tomoo Nakata, Koji Maemu ...
    2013 年 52 巻 3 号 p. 345-349
    発行日: 2013年
    公開日: 2013/02/01
    ジャーナル オープンアクセス
    Objective Previous studies have shown a possible role for obstructive sleep apnea syndrome (OSAS) in the development and/or progression of chronic kidney disease (CKD). However, the impact of treatment for OSAS on CKD has not been clarified. The aim of this study was to investigate the influence of OSAS and the short-term effects of nasal continuous positive airway pressure (CPAP) on the estimated glomerular filtration rate (eGFR).
    Methods We evaluated 38 men with OSAS diagnosed on polysomnography. The associations between the eGFR and patient characteristics, including polysomnographic parameters, were evaluated. A multivariate linear regression analysis was performed to determine the independent variables associated with eGFR. We reassessed the polysomnographic data and eGFR values after three months of CPAP treatment.
    Results The mean serum creatinine level was 0.83±0.10 mg/dL and the mean eGFR was 77.3±12.0 mL/min/1.73 m2. A univariate analysis revealed that an older age (p<0.001), a longer mean apnea duration (p=0.006) and BMI (p=0.022) were significantly associated with lower eGFRs. A multivariate linear regression analysis showed that the independent factors associated with lower eGFRs were older age (p<0.001) and a longer mean apnea duration (p=0.048). Three months after CPAP treatment, there were significant decreases in the serum creatinine levels (p=0.013) and increases in eGFR (p=0.014).
    Conclusion OSAS, especially that associated with an older age and a longer mean apnea duration, may contribute to lowering eGFR values, which can be reversed by CPAP treatment.
CASE REPORTS
PICTURES IN CLINICAL MEDICINES
LETTERS TO THE EDITORS
feedback
Top