Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
53 巻, 14 号
選択された号の論文の30件中1~30を表示しています
EDITORIAL
ORIGINAL ARTICLES
  • Kenichi Miyoshi, Yuichiro Ikebuchi, Chihiro Ishida, Kinya Okamoto, Yos ...
    2014 年 53 巻 14 号 p. 1461-1468
    発行日: 2014年
    公開日: 2014/07/15
    ジャーナル オープンアクセス
    Objective Fibrogenic cytokines, such as transforming growth factor-beta 1 play a central role in the progression of liver fibrosis. Recently, functional gene polymorphisms in these cytokines have been identified, and some reports have validated the presence of associations between these polymorphisms and disease progression. Connective tissue growth factor (CTGF) is a stimulating factor for fibroblast proliferation and matrix production. This study aimed to examine the relationship between CTGF gene polymorphisms and the progression of hepatitis C virus (HCV)-related chronic liver disease, as well as the incidence and prognosis of hepatocellular carcinoma (HCC).
    Methods A review was conducted among 235 HCV patients (117 patients with chronic hepatitis (CH) and 118 patients with liver cirrhosis (LC)). The CTGF gene polymorphism (rs6918698; -945 G/C) was identified according to the chimeric cycling probe method. The rate of liver fibrosis progression was measured using two liver fibrosis prediction formulas, the Forns index and the FibroIndex. All HCC patients were followed regularly every month.
    Results The frequency of the -945 C allele was higher among the LC patients than the CH patients. Regarding the rate of liver fibrosis progression over five years, C homozygotes tended to exhibit a faster rate than G carriers, although the difference was not significant. Among the LC patients, the C homozygotes demonstrated lower prothrombin times, higher rates of indocyanine green retention and higher Child-Pugh scores than the G carriers. There were no significant tendencies in the genotype distribution, irrespective of the status of HCC. However, the prognosis of HCC was poorer for the C homozygotes than for the G carriers.
    Conclusion A CTGF -945 C homozygote status is a significant risk factor for the progression of HCV-related chronic liver disease, including HCC.
  • Masaya Saito, Yoshihiko Yano, Akihiro Minami, Hirotaka Hirano, Kenji M ...
    2014 年 53 巻 14 号 p. 1469-1475
    発行日: 2014年
    公開日: 2014/07/15
    ジャーナル オープンアクセス
    Objective The supplementation of oral branched-chain amino acid (BCAA) granules is known to improve energy metabolism in cirrhotic patients, but not those with hepatocellular carcinoma (HCC). We aimed to clarify whether BCAA granules improve energy metabolism in HCC patients after radiofrequency ablation (RFA).
    Methods We performed a prospective cohort study (UMIN000004624) involving 40 HCC patients who underwent RFA at Kobe University Hospital. Indirect calorimetry and urinary/blood biochemical examinations were performed before and seven days after RFA. Blood biochemical examinations were also conducted three months after RFA. The patients treated with and without BCAA supplementation were compared, and univariate factors were statistically examined.
    Results The non-protein respiratory quotient (npRQ) and albumin levels before RFA were significantly lower in the BCAA group than in the control group (p=0.024 and 0.005). The npRQ ratio (seven days after/before RFA) was significantly higher in the BCAA group than in the control group (p=0.019). In addition, the albumin ratio (three months after/before RFA) was significantly higher in the BCAA group than in the control group (p=0.018).
    Conclusion Supplementation with BCAA granules improves energy metabolism in addition to the liver function after RFA. Improvements in the liver function may result in consistently adequate treatment for HCC recurrence after RFA.
  • Abdullah Nabi Aslan, Hüseyin Ayhan, Ömer Faruk Çi&cce ...
    2014 年 53 巻 14 号 p. 1477-1484
    発行日: 2014年
    公開日: 2014/07/15
    ジャーナル オープンアクセス
    Objective Several studies have shown that arterial stiffness and ventricular dysfunction are increased in individuals with type 2 diabetes. Aortic stiffness (AS) reflects the mechanical tension and elasticity of the aorta, and increased aortic stiffness is a risk factor for cardiovascular disease. The aim of this study was to evaluate the degree of aortic stiffness and its relationship with the left ventricular (LV) function in patients with prediabetes and healthy control subjects.
    Methods The study groups were composed of 50 patients with prediabetes and 47 healthy adults with similar demographic characteristics. The LV systolic and diastolic functions were assessed using standard two dimensional (2D) echocardiography, M-mode echocardiography, pulsed-wave (PW) echocardiography and tissue Doppler echocardiography. The degree of aortic strain and distensibility were calculated based on the aortic diameters measured on M-mode echocardiography at a level 3 cm above the aortic valve and the blood pressure values obtained on sphygmomanometry.
    Results There were significant differences between the prediabetic and control groups in the degree of aortic strain (4.7±2.8% vs. 14.9±4.5%; respectively, p<0.001) and distensibility (2.0±1.5 vs. 6.8±2.3; 10-3 cm2 dyn-1, respectively, p<0.001). In addition, significant differences were observed between the patient and control groups in the parameters of the LV systolic and diastolic functions. The left atrial diameter was significantly larger in the prediabetics than in the controls (35.9±3.9 vs. 33.7±4.2; respectively, p=0.027).
    Conclusion AS is increased in patients with prediabetes. In addition, there is a significant relationship between the degree of aortic stiffness and the LV function in this patient population. Therefore, the aortic elasticity parameters calculated on 2D echocardiography are useful for predicting early cardiovascular risks in prediabetics.
  • Yukitoshi Sakao, Takeshi Sugiura, Takayuki Tsuji, Naro Ohashi, Hideo Y ...
    2014 年 53 巻 14 号 p. 1485-1490
    発行日: 2014年
    公開日: 2014/07/15
    ジャーナル オープンアクセス
    Objective The goal of this study was to clarify the clinical manifestation of hypercalcemia due to hypoadrenalism in hemodialysis (HD) patients.
    Methods We retrospectively analyzed the clinical characteristics of five HD patients who had presented with hypercalcemia due to adrenal insufficiency (age: 69±7 [58-75] years old, time on HD: 13±11 [2-32] years). We conducted corticotropin-releasing hormone (CRH) and adrenocorticotropic hormone (ACTH) stimulation tests. We also examined serum bone turnover markers before and after glucocorticoid replacement.
    Results All patients had critical illnesses at the onset of hypercalcemia. They had at least one symptom, such as eosinophilia, hypoglycemia, or fever. The prevalence of hypercalcemia due to adrenal insufficiency was 1.3% in maintenance HD patients on admission. The causes of adrenal insufficiency were isolated ACTH deficiency, pituitary apoplexy, pituitary atrophy, glucocorticoid withdrawal syndrome, and unilateral adrenalectomy. Serum calcium (Ca) levels corrected by serum albumin were maximally increased to 12.9 to 14.3 mg/dL in four anuric HD patients and mildly elevated to 10.4 mg/dL in a patient with residual diuresis. Their basal serum cortisol levels ranged from <1.0 to 15.4 μg/dL. Single CRH injections failed to increase serum cortisol in any of the patients. Glucocorticoid replacement acutely normalized serum Ca and decreased levels of carboxy-terminal telopeptide of type I collagen, a marker of bone resorption.
    Conclusion Adrenal insufficiency could therefore be an occult cause of hypercalcemia in anuric HD patients who are critically ill.
  • Eiko Takahashi, Kengo Moriyama, Minoru Yamakado, the Ningen Dock Data ...
    2014 年 53 巻 14 号 p. 1491-1496
    発行日: 2014年
    公開日: 2014/07/15
    ジャーナル オープンアクセス
    Objective The Japan Diabetes Society (JDS) has recommended target levels of glycemic control based on guidelines for the management of diabetes mellitus (DM). The Japan Society of Ningen Dock created a database of subjects receiving annual health examinations nationwide. Using this database, we evaluated the efficacy of current treatment for patients with DM based on the JDS recommendations.
    Methods This multicenter, retrospective study was conducted using data obtained from 21 institutions across Japan. In order to assess the level of glycemic control in the Japanese population, we analyzed previously obtained measurements of HbA1c in 7,180 patients 20 to 79 years of age (mean age: 57.9±8.7 years, 6,007 men and 1,173 women) taking DM medications.
    Results According to the JDS guidelines, 44.7% of the patients fell into the good glycemic control group, with an HbA1c level of <7.0% while 22.4% were classified into the poor glycemic control group, with an HbA1c level of ≥8.0%. The control of other arteriosclerosis risk factors deteriorated as the glycemic control deteriorated. Lifestyle factors were strongly found to be associated with glycemic control in the patients receiving DM treatment.
    Conclusion Aggressive lifestyle modification is needed to improve glycemic control in patients with DM.
  • Atsuko Nakajima, Junko Yazawa, Daisuke Sugiki, Mari Mizuguchi, Hironor ...
    2014 年 53 巻 14 号 p. 1497-1503
    発行日: 2014年
    公開日: 2014/07/15
    ジャーナル オープンアクセス
    Objective Sepsis is one of the leading causes of mortality in critically ill patients, and providing a timely diagnosis and early intervention is necessary for successful treatment. Procalcitonin (PCT) may be a better marker of sepsis than conventional inflammatory markers. The aim of this study was to evaluate the clinical utility of the PCT level as a marker of sepsis.
    Methods Forty-five patients with sepsis, 24 patients with pneumonia who did not meet the SIRS criteria (PN) and 56 controls were enrolled in this study. The levels of PCT and other serum markers were measured, and their utility as markers of sepsis was assessed.
    Results The serum PCT levels exhibited statistically significant differences between the three groups (p<0.0001). The PCT levels in the sepsis group (29.3±85.3 ng/mL) were significantly higher (p<0.001) than those observed in the PN group (0.34±8.6 ng/mL) and the control group (0.74±2.1 ng/mL), according to a post hoc analysis. There were no differences in the white blood cell (WBC) counts or C-reactive protein (CRP) levels between the three groups. Fourteen of the 45 patients with sepsis had positive microbiological blood cultures (Gram-positive cocci [GPC] in seven patients, Gram-negative rods [GNR] in six patients, other types of bacteria in one patient). The 13 patients with GNR or GPC were categorized into the GNR group or GPC group according to the identified pathogens. The serum PCT levels were significantly higher in the GNR group (149.8±199.7 ng/mL) than in the GPC group (19.1±41.8 ng/mL) (p<0.05), although there were no differences in the WBC counts or CRP levels between these groups. When the cut-off value for the PCT level was set at 16.9 ng/mL, the sensitivity and specificity for the detection of GNR infection were 85.7% and 83.3%, respectively.
    Conclusion The PCT level is a potentially useful marker of the type of causative pathogen in patients with sepsis whose measurement may facilitate the selection of appropriate empiric antibiotic treatment.
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