Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
Volume 54 , Issue 19
Showing 1-26 articles out of 26 articles from the selected issue
ORIGINAL ARTICLES
  • Eiji Oda
    2015 Volume 54 Issue 19 Pages 2427-2432
    Published: 2015
    Released: October 01, 2015
    JOURNALS OPEN ACCESS
    Objective The purpose of this study is to investigate the relationships between serum cholinesterase and body weight change, in addition to incident obesity defined as a body mass index (BMI) of 25 kg/m2 or greater.
    Methods A retrospective 5-year follow-up study was conducted. The crude incidence and hazard ratios (HRs) of obesity adjusted for the BMI and other confounders were calculated for cholinesterase quartiles in 1,412 men and 921 women. Partial correlation coefficients (PCCs) were calculated between cholinesterase and changes in the BMI during the 5-year follow-up period adjusted for age and other confounders and the change in the BMI were compared among cholinesterase quartiles in 1,223 men and 681 women.
    Results During the 5-year follow-up period, 149 men (10.6%) and 65 women (7.1%) developed obesity. The adjusted HRs of obesity decreased, although the crude incidence of obesity increased along the quartiles of cholinesterase in men. The adjusted HRs of obesity for the first (lowest), second and third quartiles of cholinesterase were 2.02 (p=0.006), 1.45 (p=0.122), and 1.28 (p=0.265), respectively compared with the highest quartile in men. The PCC between the baseline level of cholinesterase and change in the BMI was -0.16 (p<0.001) in men. The mean changes in BMI for 5 years were 0.31 kg/m2, 0.17 kg/m2, 0.01 kg/m2 and -0.04 kg/m2, respectively in the first, second, third and fourth quartiles of cholinesterase in men (p=0.005). Neither incident obesity nor weight gain was significantly associated with cholinesterase in women.
    Conclusion The serum cholinesterase level was inversely associated with body weight change, as well as incident obesity, after adjusted for the BMI in men.
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  • Takeshi Hayashi, Yuji Kato, Takuya Fukuoka, Ichiro Deguchi, Hajime Mar ...
    2015 Volume 54 Issue 19 Pages 2433-2437
    Published: 2015
    Released: October 01, 2015
    JOURNALS OPEN ACCESS
    Objective Anticoagulation therapy with warfarin is associated with a favorable prognosis in ischemic stroke. Dabigatran, a new oral anticoagulant, is widely used to prevent ischemic stroke in non-valvular atrial fibrillation (NVAF) patients. However, its association with decreased severity and a favorable prognosis once ischemic stroke has occurred remains unknown.
    Methods We retrospectively reviewed all the patients with NVAF-associated ischemic stroke admitted to our hospital from April 2011 to December 2014 and included those who received dabigatran therapy. We assessed whether the patients were under regular use of the drug or discontinuance and classified them into 2 groups, the treatment and discontinuation groups. Clinical data, including the age, sex, ASCOD stroke phenotype, NVAF type, prescribed drug dose, comorbidities, CHADS2 score, renal function, National Institute of Health Stroke Scale (NIHSS) score on admission, modified Rankin scale (mRS) score at discharge, D-dimer, and brain natriuretic peptide, were investigated and compared between the groups.
    Results Nine patients were under regular dabigatran therapy, and 6 were under discontinuance of the drug. The age, sex, ASCOD stroke phenotype, NVAF type, comorbidities, renal function, and CHADS2 scores did not differ between the 2 groups; however, the NIHSS scores were significantly lower in the treatment group. The mRS scores at discharge were additionally decreased in the treatment group. Moreover, the D-dimer scores were lower in the treatment group, thus suggesting a possible role in the decreased stroke severity.
    Conclusion Dabigatran may therefore decrease the severity of ischemic stroke, even if ischemic stroke occurs.
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CASE REPORTS
  • Mitsuaki Ishioka, Mario Jin, Tamotsu Matsuhashi, Suguru Arata, Yusato ...
    2015 Volume 54 Issue 19 Pages 2439-2442
    Published: 2015
    Released: October 01, 2015
    JOURNALS OPEN ACCESS
    Primary enterolith is a rare condition that can induce ileus and intestinal perforation. We report the first case of a true primary enterolith treated by balloon-assisted enteroscopy. The patient presented with a small intestinal ileus. After its improvement following the insertion of an ileus tube, radiography with amidotrizoate sodium meglumine detected a round, movable defect in the ileum measuring 42 mm diameter. The patient was diagnosed with a primary enterolith based on her past history. The enterolith was fractured and removed using balloon-assisted enteroscopy. This case suggests that balloon-assisted enteroscopy may be an effective non-invasive treatment option for enteroliths.
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  • Sota Minami, Michihiko Shibata, Toru Matsuhashi, Masaaki Hiura, Shinta ...
    2015 Volume 54 Issue 19 Pages 2443-2447
    Published: 2015
    Released: October 01, 2015
    JOURNALS OPEN ACCESS
    A young pregnant woman was hospitalized due to hepatitis B virus (HBV)-related acute liver failure (ALF). The cardiac function was normal on admission. However, she developed ALF concurrently with a coma and severe cardiac failure. The patient was diagnosed with severe acute cardiomyopathy due to diffuse hypokinesis of the left ventricle wall on ultrasound cardiography. Following intensive treatment, both the liver and cardiac function dramatically recovered. Although some factors, such as HBV, pregnancy and systemic inflammatory response syndrome, are possible causes of acute cardiomyopathy in the present case, ALF itself may be a risk factor for heart failure.
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  • Jingfeng Wang, Haiyan Chen, Yangang Su, Junbo Ge
    2015 Volume 54 Issue 19 Pages 2449-2451
    Published: 2015
    Released: October 01, 2015
    JOURNALS OPEN ACCESS
    A 63-year-old patient who had undergone atrial septal defect surgical repair received implantation of a single chamber VVI pacemaker for long RR intervals during atrial fibrillation. One week later, an intermittent loss of capture and sensing failure was detected at a pacing rate of 70 beats/min. However, a successful capture was observed during rapid pacing. Consequently, the pacing rate was temporarily adjusted to 90 beats/min. At the 3-month follow-up, the pacemaker was shown to be functioning properly independent of the pacing rate. An echocardiogram showed that the increased pacing rates were accompanied by a reduction in the right ventricular outflow tract dimension. The pacemaker was then permanently programmed at a lower rate of 60 beats/min.
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  • Tomohiro Honda, Hiroaki Kawano, Akira Tsuneto, Tomoo Nakata, Takeo Yos ...
    2015 Volume 54 Issue 19 Pages 2453-2458
    Published: 2015
    Released: October 01, 2015
    JOURNALS OPEN ACCESS
    Coronary artery aneurysms are frequently asymptomatic and may be difficult to diagnose by cardiac imaging. We herein present a case of a coronary artery aneurysm of the right coronary artery due to medial mucoid degeneration mimicking an intra-atrial mass on echocardiography and magnetic resonance imaging, with the cause being diagnosed after surgery.
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  • Gaurang Vaidya, Muhammad Sarwar, Zongxia Sun, Tiemin Wei, Kan Liu
    2015 Volume 54 Issue 19 Pages 2459-2462
    Published: 2015
    Released: October 01, 2015
    JOURNALS OPEN ACCESS
    Pulmonary hypertension (PH) worsens the mortality of the patients with sickle cell disease (SCD). The exact mechanism of PH development/progression in SCD, including the role of tricuspid regurgitation (TR), remains unclear. We herein report an unusual SCD case, complicated by chronic thromboembolic disorder, who developed severe TR and an accelerated progression of PH. Tricuspid valve surgery significantly ameliorated the patient's symptoms and reduced hospital readmission. The early detection and management of the reversible disorder accelerating the PH development in SCD patients may alter the clinical course, improve the quality of life, and potentially affect the long-term outcome.
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  • Mai Shimbo, Hiroyuki Watanabe, Tatsumi Abe, Teruki Sato, Takashi Koyam ...
    2015 Volume 54 Issue 19 Pages 2463-2465
    Published: 2015
    Released: October 01, 2015
    JOURNALS OPEN ACCESS
    Infective endocarditis (IE) associated with atrial septal defect (ASD) is extremely rare. However, tricuspid regurgitation (TR) secondary to right ventricular overload is a potential cause of IE, and once it occurs, the development of a paradoxical embolism may lead to fatal complications. We herein report the case of a 50-year-old woman who was admitted due to a persistent fever resistant to antibiotics. Echocardiography showed secundum ASD, moderate TR and a mobile vegetation measuring 15×10 mm attached to the tricuspid valve. Given the risk of developing a paradoxical embolism, urgent surgery was successfully performed.
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  • Fumihiko Takahashi, Masahide Goto, Yoshiki Wada, Naoyuki Hasebe
    2015 Volume 54 Issue 19 Pages 2467-2470
    Published: 2015
    Released: October 01, 2015
    JOURNALS OPEN ACCESS
    A 28-year-old man was referred to our hospital for the treatment of congestive heart failure and severe hypertension. The patient was diagnosed with malignant phase hypertension based on the presence of marked hypertension with left ventricular hypertrophy, exudate retinopathy, and renal failure. Intensive therapy for hypertension and heart failure with a combination of antihypertensive drugs including nitroglycerin, nifedipine, eplerenone and candesartan successfully lowered his blood pressure and further improved the renal function. Eplerenone could be one of the choices of antihypertensive drugs in combination therapy in patients with malignant phase hypertension with progressive heart and renal failure.
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  • Soo Kyoung Kim, Bo Ra Kim, Kyongyoung Kim, Sungsu Kim, Jung Hwa Jung, ...
    2015 Volume 54 Issue 19 Pages 2471-2474
    Published: 2015
    Released: October 01, 2015
    JOURNALS OPEN ACCESS
    Endocrine diseases are frequently accompanied by diabetes mellitus and treatment of an underlying endocrine disease often improves glucose control. The co-occurrence of acromegaly and Cushing's syndrome is extremely rare. We herein describe a patient who showed a dramatic improvement in glucose control following treatment for co-existing acromegaly and Cushing's syndrome. An adrenal mass was incidentally discovered during a routine evaluation of a 56-year-old woman who was subsequently diagnosed with acromegaly and a unilateral cortisol-producing adrenal adenoma. Her blood glucose was poorly controlled despite receiving high-dose insulin therapy. After undergoing adrenalectomy for Cushing's syndrome, her insulin dosage was decreased by almost 50%. The insulin treatment was discontinued following the treatment of acromegaly.
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  • Takaaki Murakami, Takeshi Usui, Akio Nakajima, Yuki Mochida, Sumio Sai ...
    2015 Volume 54 Issue 19 Pages 2475-2481
    Published: 2015
    Released: October 01, 2015
    JOURNALS OPEN ACCESS
    A 35-year-old obese diabetic man presented with recurrent primary hyperparathyroidism during a three-year outpatient follow-up. He was clinically diagnosed with multiple endocrine neoplasia type 1 (MEN1) due to the presence of a pituitary adenoma and multiple glucagonomas. The glucagonomas may have affected his glycemic control. However, he did not demonstrate weight loss, suggesting that the patient's obesity could have obscured the early diagnosis of a glucagonoma. Genetic testing revealed a novel missense mutation at codon 561 in exon 10, resulting in an amino acid substitution from methionine to arginine (M561R) in the MEN1 gene. This mutation appeared to be responsible for the MEN1 pathogenicity.
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  • Masato Taki, Naoya Ikegami, Chisato Konishi, Satoshi Nakao, Tomoko Fun ...
    2015 Volume 54 Issue 19 Pages 2483-2486
    Published: 2015
    Released: October 01, 2015
    JOURNALS OPEN ACCESS
    Lung lesions often appear in patients with sarcoidosis; however, miliary opacities are rare. We herein report the case of a 40-year-old woman with pulmonary sarcoidosis who presented with dyspnea on exertion. Subsequent computed tomography showed miliary opacities, and the presence of granulomas was confirmed by a transbronchial lung biopsy. Glucocorticoid therapy was initiated and the symptoms and miliary opacities rapidly improved. Although miliary sarcoidosis is uncommon, physicians should consider sarcoidosis in addition to tuberculosis, malignancy, and pneumoconiosis when presented with miliary opacities.
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  • Naoki Omachi, Tomoya Kawaguchi, Shigeki Shimizu, Tomohisa Okuma, Masan ...
    2015 Volume 54 Issue 19 Pages 2487-2489
    Published: 2015
    Released: October 01, 2015
    JOURNALS OPEN ACCESS
    This report describes the case of a 23-year-old man with a mediastinal teratoma. Five months before admission, a chest radiograph during a routine health checkup was normal. Four months before admission, the patient developed sudden onset of mild right-sided chest pain. He gradually developed dyspnea and was admitted to our hospital. Computed tomography revealed a giant tumor that was markedly compressing the right atrium. Urgent surgery was performed, and a ruptured, benign mature teratoma was diagnosed. Mature mediastinal teratomas are benign tumors, but they can rupture and have the potential to grow rapidly, potentially leading to life-threatening complications.
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  • Makoto Furugen, Kayoko Uechi, Jun Hirai, Hajime Aoyama, Masanao Saio, ...
    2015 Volume 54 Issue 19 Pages 2491-2496
    Published: 2015
    Released: October 01, 2015
    JOURNALS OPEN ACCESS
    We herein describe the case of a 63-year-old man who died from relapsed epidermal growth factor receptor gene (EGFR) exon 19 deletion lung adenocarcinoma treated with erlotinib. According to the autopsy results, he was confirmed to have small cell carcinoma without the EGFR T790M mutation in his pancreas and left kidney metastatic specimens, while the adenocarcinoma metastatic lesion in his right kidney had the EGFR T790M mutation; both retained the somatic EGFR exon 19 deletion. We herein report an autopsy case of resistance to an EGFR tyrosine kinase inhibitor via small cell carcinoma transformation and the EGFRT790M mutation in separate metastatic organs.
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  • Natsumi Furuta, Kunihiko Ishizawa, Makoto Shibata, Setsuki Tsukagoshi, ...
    2015 Volume 54 Issue 19 Pages 2497-2501
    Published: 2015
    Released: October 01, 2015
    JOURNALS OPEN ACCESS
    We herein investigated the clinical features of three patients with anti-muscle-specific tyrosine kinase (MuSK) antibody-positive myasthenia gravis (MG), which was initially difficult to distinguish from amyotrophic lateral sclerosis (ALS). The patients exhibited dropped head syndrome or dysphagia as initial symptoms. Although their clinical findings were compatible with the revised El Escorial Criteria for ALS, their progression appeared to be more rapid than that of ALS. Both the edrophonium and repetitive nerve stimulation tests yielded negative results, and diurnal fluctuation was not confirmed. The patients were ultimately diagnosed with anti-MuSK antibody-positive MG. We therefore recommend the measurement of anti-MuSK antibodies when encountering such cases.
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  • Yuji Tomizawa, Ayami Okuzumi, Hiromi Shiotsuki, Kazuyuki Noda, Nobutak ...
    2015 Volume 54 Issue 19 Pages 2503-2506
    Published: 2015
    Released: October 01, 2015
    JOURNALS OPEN ACCESS
    A 76-year-old man was admitted to our hospital due to gait difficulty. Brain imaging indicated bilateral pulvinar lesions and moderate white matter lesions. The serum α-galactosidase A levels were measured for the differential diagnosis of bilateral pulvinar lesions and were found to be abnormally low. Therefore, the patient was suspected to have variant Fabry disease. A GLA mutation analysis showed the p.E66Q mutation, which is speculated to be a functional polymorphism rather than a disease-causing mutation of Fabry disease. Enzyme replacement therapy did not result in a marked improvement, however, the disease progression stopped.
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  • Takashi Nakanishi, Hideyuki Horikoshi, Yasuyoshi Kusanagi, Takeshi Yam ...
    2015 Volume 54 Issue 19 Pages 2507-2511
    Published: 2015
    Released: October 01, 2015
    JOURNALS OPEN ACCESS
    We herein describe a case of refractory dermatomyositis (DM) complicated with myelodysplastic syndrome (MDS). Despite intensive immunosuppressive therapies, the activity of myositis, skin ulcers, and interstitial pneumonia did not improve. The patient ultimately died following the progression of interstitial pneumonia. There are few reports of DM accompanying MDS to date, and any association in the pathogenesis between the two is still unclear. However, underlying MDS may have the potential to influence the therapeutic response of DM.
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  • Daisuke Shibahara, Takeshi Kinjo, Naoya Nishiyama, Wakaki Kami, Daijir ...
    2015 Volume 54 Issue 19 Pages 2513-2516
    Published: 2015
    Released: October 01, 2015
    JOURNALS OPEN ACCESS
    A 65-year-old man, who recently returned from Liberia, visited a clinic complaining of fever, and azithromycin was prescribed. The patient presented to a general hospital 5 days after the onset of symptoms, however, a blood smear examination failed to detect malaria. Contrary to the blood smear result, a rapid antigen test in our hospital was strongly-positive for falciparum malaria, indicating a high level of malarial antigen in the blood. Moreover, laboratory examinations on admission showed a tendency for improvement. We assumed that the administration of azithromycin partially treated malaria, thus complicating the blood smear diagnosis. We should be careful in prescribing azithromycin, which is widely used in clinics, to travelers returning from malaria-endemic countries.
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  • Kouhei Ishikawa, Hiromichi Ohsaka, Kazuhiko Omori, Mariko Obinata, Ken ...
    2015 Volume 54 Issue 19 Pages 2517-2520
    Published: 2015
    Released: October 01, 2015
    JOURNALS OPEN ACCESS
    We herein report the fourth case of a pregnant woman bitten by a mamushi. A 33-year-old pregnant woman in the 25th week of gestation was bitten by a mamushi. Her vital signs were stable; however, biochemical analyses of the blood showed mild deterioration of anemia and hypoproteinemia. The effects of envenomation were limited to the extremities, the administration of supportive therapy without antivenom fortunately resulted in a favorable outcome. As there are differences in the maternal medical condition and weeks of gestation, further research is needed to clarify the optimal management strategy for administering antivenom in pregnancy.
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