Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
52 巻, 7 号
選択された号の論文の32件中1~32を表示しています
ORIGINAL ARTICLES
  • Jun-ichi Kotani, Yuji Ikari, Eishou Kyo, Masato Nakamura, Hiroyoshi Yo ...
    2013 年 52 巻 7 号 p. 703-711
    発行日: 2013年
    公開日: 2013/04/01
    ジャーナル オープンアクセス
    Objective To investigate the risks and benefits of prolonged dual antiplatelet therapy (DAPT: thienopyridine plus aspirin) following placement of drug-eluting stents (DES). The optimal duration of DAPT is not well established.
    Methods We analyzed a prospective registry of 2,050 patients with sirolimus-eluting stents during a 5-year follow-up. We divided 1,691 patients into two groups according to DAPT duration (DAPT ≤12 months (n=749) and DAPT >12 months (n=942)) and compared the clinical outcomes using a landmark analysis.
    Results The frequencies of major adverse cardiac events (MACE: 15.6% vs. 18.2%), death (10.0% vs. 11.5%), myocardial infarction (2.3% vs. 2.1%), target lesion revascularization (4.5% vs. 6.3%) and stent thrombosis (0.8% vs. 0.8%) were similar between the two groups. However, the frequency of bleeding was higher in the DAPT >12 months group (1.1% vs. 2.6%, p=0.030). The adjusted 12-month landmark analysis showed no differences in the incidence of MACE (hazard ratio (HR) 0.892; 95% confidence interval (CI) 0.689-1.155; p=0.385) or a composite of target vessel revascularization, cardiac death and myocardial infarction (target vessel failure: HR 0.922; 95% CI 0.678-1.255; p=0.606). There were no differences in the frequency of stent thrombosis between the two groups during years 2 to 5 after stenting; however, with regard to bleeding, an increase in the frequency of hemorrhage events was observed after four years from the index procedures in the DAPT >12 months group.
    Conclusion DAPT performed beyond 12 months is associated with increased an frequency of bleeding complications and does not prevent the incidence of MACE, including stent thrombosis, during five years of follow-up after sirolimus-eluting stent implantation. Conducting larger, randomized studies will therefore be needed to confirm this finding.
  • Joji Morii, Shin-ichiro Miura, Amane Ike, Yuhei Shiga, Makoto Sugihara ...
    2013 年 52 巻 7 号 p. 713-719
    発行日: 2013年
    公開日: 2013/04/01
    ジャーナル オープンアクセス
    Objective We compared the efficacies of irbesartan and olmesartan after successful stent implantation in patients with stable angina.
    Methods Twenty-six patients were randomly divided into irbesartan and olmesartan groups and treated for approximately eight months (at follow-up coronary angiography).
    Results There were no differences in blood pressure (BP) reduction or late loss between the groups. The BP levels in both groups at follow-up were significantly reduced. The equality of variance of systolic (S)BP (i.e., the intragroup standard deviation of SBP) in the irbesartan group was significantly smaller than that observed in the olmesartan group at follow-up. In addition, log[pentraxin-3] was significantly decreased in all of the patients at follow-up, with no differences between the groups. Interestingly, the levels of log[high-sensitive C-reactive protein(hs-CRP)] measured at 0 weeks were positively associated with in-stent late loss, and among independent biochemical variables in addition to age, gender, body mass index and the kind of angiotensin receptor blockers at 0 weeks, only these levels were related to in-stent late loss, as assessed by a multivariate analysis.
    Conclusion The ability of irbesartan to reduce BP is comparable to that of olmesartan, and irbesartan exhibits a lower variance of systolic BP after treatment. The level of log[hs-CRP] before stent implantation is a predictor of in-stent late loss.
  • Eiji Oda, Yoshifusa Aizawa
    2013 年 52 巻 7 号 p. 721-725
    発行日: 2013年
    公開日: 2013/04/01
    ジャーナル オープンアクセス
    Objective Although metabolic syndrome (MS) is considered to be a predictor of diabetes and cardiovascular disease, its value for predicting diabetes beyond the levels of fasting glucose (FG) and hemoglobin A1c (HbA1c) remains questionable. In this study, we evaluated the usefulness of MS and Japanese MS (JMS) as predictors of diabetes.
    Methods This study is a longitudinal study using data for 2,034 subjects who visited our Medical Check-up Center in both 2008 and 2011 and were free from diabetes at baseline. The odds ratios (ORs) of developing diabetes in 2011 for MS and JMS were calculated after being adjusted for FG, age, sex and antihypertensive and antihyperlipidemic medication use, then further adjusted for HbA1c. The optimal cutoff points for FG, HbA1c and body mass index (BMI) to discriminate the development of diabetes and their sensitivities/specificities were obtained from receiver operating characteristic curves. These sensitivities/specificities were compared with the sensitivities/specificities of MS and JMS.
    Results The ORs (95% confidence intervals (CIs)) of developing diabetes for MS and JMS were 1.36 (0.57-3.23) (p=0.484) and 3.23 (1.25-8.36) (p=0.016), respectively, after being adjusted for FG and 1.06 (0.39-2.86) (p=0.915) and 2.34 (0.79-6.95) (p=0.126), respectively, after being further adjusted for HbA1c. The sensitivities/specificities of FG, HbA1c, BMI, MS and JMS were 0.625/0.897, 0.828/0/919, 0.625/0.734, 0.375/0.911, and 0.375/0.941, respectively.
    Conclusion MS and JMS were found to be poor predictors of diabetes in a Japanese health screening population.
  • Keitaro Nakamoto, Noboru Takayanagi, Tetsu Kanauchi, Takashi Ishiguro, ...
    2013 年 52 巻 7 号 p. 727-734
    発行日: 2013年
    公開日: 2013/04/01
    ジャーナル オープンアクセス
    Objective The prognostic factors of chronic necrotizing pulmonary aspergillosis remain unclear. We assessed the prognostic factors of all-cause mortality in patients with chronic necrotizing pulmonary aspergillosis, focusing especially on underlying pulmonary disease, first-line treatment and host predisposition.
    Methods We retrospectively analyzed the medical records of 194 patients negative for HIV who had chronic necrotizing pulmonary aspergillosis treated at our institution in Saitama, Japan.
    Results The patients (median age, 68.5 years) were followed over a median follow-up time of 2.6 years. The underlying pulmonary diseases consisted of previous pulmonary tuberculosis in 59 (30.4%) patients, emphysema in 39 (20.1%) patients, interstitial lung disease in 32 (16.5%) patients, nontuberculous mycobacteriosis in 29 (14.9%) patients and other diseases in 35 (18%) patients. The first-line treatments included observation in 65 (33.5%) patients, itraconazole in 56 (28.9%) patients, micafungin in 46 (23.7%) patients, voriconazole in 22 (11.3%) patients and amphotericin B (including liposomal amphotericin B) in five (2.6%) patients. The overall cumulative mortality rate was 50.2% at five years and 67.4% at 10 years. Multivariate Cox proportional hazard modeling found an older age, the presence of systemic comorbidities, baseline corticosteroid use, a body mass index of <18.5 kg/m2 and a C-reactive protein level of ≥5.0 mg/dL to be negative prognostic factors for all-cause mortality.
    Conclusion The 5-year mortality rate of chronic necrotizing pulmonary aspergillosis was 50.2%. When clinical trials are designed and implemented to test effective drug therapies in patients with chronic necrotizing pulmonary aspergillosis, the trial patients should be stratified according to these prognostic factors prior to randomization.
  • Takeshi Nishijima, Misao Takano, Michiyo Ishisaka, Hirokazu Komatsu, H ...
    2013 年 52 巻 7 号 p. 735-744
    発行日: 2013年
    公開日: 2013/04/01
    ジャーナル オープンアクセス
    Objective To compare the efficacy and safety of fixed-dose abacavir/lamivudine (ABC/3TC) and tenofovir/emtricitabine (TDF/FTC) with ritonavir-boosted atazanavir (ATV/r) in treatment-naïve Japanese patients with HIV-1 infection.
    Methods A 96-week multicenter, randomized, open-label, parallel group pilot study was conducted. The endpoints were times to virologic failure, safety event and regimen modification.
    Results 109 patients were enrolled and randomly allocated (54 patients received ABC/3TC and 55 patients received TDF/FTC). All randomized subjects were analyzed. The time to virologic failure was not significantly different between the two arms by 96 weeks (HR, 2.09; 95% CI, 0.72-6.13; p=0.178). Both regimens showed favorable viral efficacy, as in the intention-to-treat population, 72.2% (ABC/3TC) and 78.2% (TDF/FTC) of the patients had an HIV-1 viral load <50 copies/mL at 96 weeks. The time to the first grade 3 or 4 adverse event and the time to the first regimen modification were not significantly different between the two arms (adverse event: HR 0.66; 95% CI, 0.25-1.75, p=0.407) (regimen modification: HR 1.03; 95% CI, 0.33-3.19, p=0.964). Both regimens were also well-tolerated, as only 11.1% (ABC/3TC) and 10.9% (TDF/FTC) of the patients discontinued the allocated regimen by 96 weeks. Clinically suspected abacavir-associated hypersensitivity reactions occurred in only one (1.9%) patient in the ABC/3TC arm.
    Conclusion Although insufficiently powered to show non-inferiority of viral efficacy of ABC/3TC relative to TDF/FTC, this pilot trial suggested that ABC/3TC with ATV/r is a safe and efficacious initial regimen for HLA-B*5701-negative patients, such as the Japanese population.
  • Ebru Kursun, Tuba Turunc, Yusuf Demiroglu, Hande Arslan
    2013 年 52 巻 7 号 p. 745-750
    発行日: 2013年
    公開日: 2013/04/01
    ジャーナル オープンアクセス
    Objective Brucellosis remains as a widespread zoonosis, both worldwide and in our country that causes serious public health problems with the potential to create disease in humans and animals. The aim of the present study was to examine the characteristics of brucellosis patients followed in our clinic and to compare these cases with those reported in the literature.
    Methods Four hundred and forty-seven patients who were treated in our clinic between March 2004 and March 2011 for a diagnosis of brucellosis and who were followed for one year after the completion of treatment were retrospectively examined. Data for the patients were obtained using brucellosis follow-up forms.
    Results Of the 447 patients, 261 (58.4%) were women, and the mean age was 48±17 years. Focal organ involvement was detected in 178 (40%) cases, with the musculoskeletal system being the leading site (30.6%), followed by the central nervous system (5.4%). Spondylodiscitis exhibited a significant correlation with an advanced age, a high erythrocyte sedimentation rate (ESR) and the C-reactive protein (CRP) level on admission (p=0.001, p=0.0001 and p=0.001, respectively). A significant correlation was found between sacroiliitis and a younger age (p=0.003). Relapse was observed in 35 (7.8%) cases.
    Conclusion The present study allowed us to scrutinize the characteristics and complications of patients with brucellosis. Focal organ involvement of the musculoskeletal system was observed in the present cases, particularly spondylodiscitis and sacroiliitis. Spondylodiscitis was detected in elderly patients with high CRP and ESR values, whereas sacroiliitiswas seen in younger patients. We believe that age, symptom duration and laboratory parameters should be evaluated in patients with brucellosis and that older patients in particular should be precisely examined for bone and joint complications.
  • Satoru Tawara, Yasuhiro Yonemochi, Takayuki Kosaka, Yanosuke Kouzaki, ...
    2013 年 52 巻 7 号 p. 751-756
    発行日: 2013年
    公開日: 2013/04/01
    ジャーナル オープンアクセス
    Objective To explore the opinions of outpatients concerning a new communication method: the self-management of assessed personal problems in health information records (SAPPHIRE) using patients' mobile phones to store and share medical content (medical SAPPHIRE, or m-SAPPHIRE).
    Methods A cross-sectional questionnaire survey.
    Patients Outpatients who visited us from March 1 to May 30, 2012, were asked to complete a questionnaire survey regarding SAPPHIRE and m-SAPPHIRE. The m-SAPPHIRE data consisted of a problem list, height, weight, waist size and active medication list. Ten questions were asked regarding the usefulness of m-SAPPHIRE, the sharing of m-SAPPHIRE and the use of mobile phones to store m-SAPPHIRE data.
    Results One hundred and ninety-three patients (male/female, 79/114; mean age, 57±21 years) were registered: 95.9% answered that m-SAPPHIRE would be useful, 98% agreed to manage their personal health records by themselves, and 95.8%, 93.8%, and 92.8% of the patients responded that they would allow m-SAPPHIRE information to be shared with family members, medical workers, and health care providers, respectively. Of the patients, 75.1% responded that they owned a mobile phone, and 43.5% answered that they could enter m-SAPPHIRE information into a mobile phone by themselves, while 27.5% responded that they could do so with someone's help.
    Conclusion Patients believe that m-SAPPHIRE would be useful for retrieving their health records during emergency situations or for sharing with family members and medical and health care providers. SAPPHIRE using mobile phones could be an inexpensive and legal method for sharing medical data.
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