Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
Volume 54 , Issue 21
Showing 1-25 articles out of 25 articles from the selected issue
EDITORIAL
CASE REPORTS
  • Koh Nakamaru, Tsukasa Ikeura, Hideaki Miyoshi, Makoto Takaoka, Naoyuki ...
    2015 Volume 54 Issue 21 Pages 2711-2715
    Published: 2015
    Released: November 01, 2015
    JOURNALS OPEN ACCESS
    A 74-year-old man was diagnosed with small cell carcinoma arising from the extrahepatic bile duct according to a histological examination of the biopsy specimen obtained during endoscopic retrograde cholangiopancreatography. Additionally, bulky hilar lymphadenopathy was observed, and the patient was treated with the combination of radiation and chemotherapy (cisplatin and irinotecan). Post-therapy, he underwent pancreaticoduodenectomy. The histological examination of the resected specimen revealed no residual cancer cells in the bile duct wall and a small amount of cancer cells in only a single lymph node. Due to this multidisciplinary therapy, the patient showed no signs of recurrence 12 months postoperatively.
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  • Cuneyt Toprak, Mahmut Yesin, Mehmet Mustafa Tabakci, Muhittin Demirel, ...
    2015 Volume 54 Issue 21 Pages 2717-2720
    Published: 2015
    Released: November 01, 2015
    JOURNALS OPEN ACCESS
    In patients with mammarycoronary bypass grafts, the presence of a subclavian artery stenosis proximal to the internal mammary artery may result in a condition termed coronary-subclavian steal syndrome of which the incidence varies between 0.07-3.4% among those requiring coronary grafts. We reported a patient with a history of the coronary artery bypass graft who presented with typical angina pectoris at rest that was exacerbated by selective exercise of the left upper extremity in whom occlusion of the left subclavian artery was demonstrated in this patient by 3D reconstruction of computed tomography angiography, a reversal blood flow in the left internal mammary artery-left anterior descending artery graft by Doppler ultrasonography, and a coronary angiography.
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  • Gusti Rizky Teguh Ryanto, Kazuhiko Nakayama, Tomofumi Takaya, Daichi F ...
    2015 Volume 54 Issue 21 Pages 2721-2726
    Published: 2015
    Released: November 01, 2015
    JOURNALS OPEN ACCESS
    Fistulas between systemic and pulmonary arteries are associated with various underlying etiologies and cause pulmonary hypertension (PH). Diagnosis of this condition requires several imaging studies and the exclusion of other possible causes of PH. We herein report a case of a patient with interstitial pneumonia and scleroderma. The imaging revealed multiple fistulas involving the inferior phrenic and left lower pulmonary arteries. The fistulas were closed using coils, but the PH remained presumably due to other undiagonosed fistulas. The improvement of symptoms following use of a supplementary pulmonary vasodilator provides the hope that the chosen treatment could be a viable alternative approach for other similar cases.
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  • Shengpu Chou, Seiji Ayabe, Nobuo Sekine
    2015 Volume 54 Issue 21 Pages 2727-2733
    Published: 2015
    Released: November 01, 2015
    JOURNALS OPEN ACCESS
    A 40-year-old diabetic man was admitted to our hospital for poor glycemic control. During hospitalization, he took 42 mg glimepiride and 50 mg zolpidem as a suicide attempt. The following day, the creatine kinase-MB fraction and troponin I levels were elevated to 112 IU/L and 8.77 ng/mL, respectively, without any electrocardiographic abnormalities. The patient recovered completely without any complications. Four weeks later, coronary computed tomography angiography and myocardial perfusion scintigraphy revealed moderate one-vessel coronary disease without the evidence of myocardial ischemia or old infarction. Cardiac-specific markers must be considered in sulfonylurea-induced hypoglycemic patients, particularly when the patient is unconscious and does not exhibit any clinical manifestations.
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  • Yasushi Yoshida, Masato Singyoji, Hironori Ashinuma, Meiji Itakura, To ...
    2015 Volume 54 Issue 21 Pages 2735-2739
    Published: 2015
    Released: November 01, 2015
    JOURNALS OPEN ACCESS
    We herein report two cases of thymomas diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). In both cases, the tumor was adjacent to the central airway. Therefore, we attempted to perform EBUS-TBNA in order to obtain specimens for a histopathological examination, which resulted in a diagnosis of thymoma. In one case, surgical resection was conducted and the histological evaluation of the resected specimen confirmed thymoma type AB, consistent with the histology from the EBUS-TBNA specimen. As a safe and minimally invasive procedure, EBUS-TBNA may be considered for the diagnosis of mediastinal tumors, including thymoma.
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  • Takayuki Shiroyama, Ayako Tanaka, Motohiro Tamiya, Masanari Hamaguchi, ...
    2015 Volume 54 Issue 21 Pages 2741-2743
    Published: 2015
    Released: November 01, 2015
    JOURNALS OPEN ACCESS
    Molecular testing for anomalies, such as epidermal growth factor receptor mutations and anaplastic lymphoma kinase (ALK) rearrangement, is part of the current standard of care for non-small cell lung cancer, particularly adenocarcinoma. ALK rearrangement occurs most frequently in adenocarcinoma cells and rarely in non-adenocarcinoma cells. We herein report a rare case of pleomorphic lung carcinoma with ALK rearrangement in both its adenocarcinoma and spindle cell components. This case suggests the possibility of ALK rearrangement in pleomorphic carcinoma.
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  • Marcelo M. Serra, Bruno L. Ferreyro, Oscar Peralta, Ezequiel Levy Yeya ...
    2015 Volume 54 Issue 21 Pages 2745-2748
    Published: 2015
    Released: November 01, 2015
    JOURNALS OPEN ACCESS
    Hereditary hemorrhagic telangiectasia (HHT) usually presents in association with pulmonary arteriovenous malformations (PAVMs). In addition, the incidence of venous thromboembolism tends to be increased in these patients. A 74-year-old female with HHT presented with cyanosis and hypoxemia. Contrast-enhanced multislice computed tomography (MSCT) revealed two left PAVMs and one in the right upper lobe. Both left PAVMs were treated with embolotherapy. Follow-up MSCT revealed an incidental pulmonary embolism in the right pulmonary branches. Deep venous thrombosis was confirmed and anticoagulation was initiated. Follow-up MSCT revealed the resolution of thromboembolism. Finally, embolotherapy was performed. This case illustrates the chronic adaptation to hypoxemia and adds further evidence to the relative safety of anticoagulation treatment in these patients.
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  • Takayoshi Tachibana, Eri Yamamoto, Rika Kawasaki, Hideyuki Koharazawa, ...
    2015 Volume 54 Issue 21 Pages 2749-2752
    Published: 2015
    Released: November 01, 2015
    JOURNALS OPEN ACCESS
    Primary graft failure occurred after cord blood transplantation for a patient with acute lymphoblastic leukemia. The second transplantation was performed using haploidentical peripheral blood. The conditioning regimen consisted of fludarabine (day -1; 30 mg/m2), cyclophosphamide (day -1; 2,000 mg/m2), and total body irradiation (day -1; 2 Gy). The immunosuppressants contained tacrolimus, prednisolone, and rabbit anti-thymocyte globulin (day -3 to -2; total dose: 3.75 mg/kg). The engraftment was confirmed on day 9. Both acute and chronic graft-versus-host disease were controllable. The present regimen appears to be suitable for immediate management, fast engraftment, and the durable control of complications.
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  • Ryuichiro Hayashi, Kozo Kitazawa, Daisuke Sanada, Noriyuki Kato, Takaf ...
    2015 Volume 54 Issue 21 Pages 2753-2758
    Published: 2015
    Released: November 01, 2015
    JOURNALS OPEN ACCESS
    A 52-year-old woman, previously treated for gastric cancer, began hemodialysis (HD) to treat the onset of severe acidemia. After her initial HD sessions, she suffered from a prolonged coma for approximately ten days. Magnetic resonance imaging revealed diffuse leukoencephalopathy, with increased apparent diffusion coefficient. Magnetic resonance spectroscopy showed a reduction of the N-acetylaspartate/creatine ratio. Her neuroimaging findings gradually resolved. Her transient cerebral white matter lesions were thought to be interstitial edema derived from dialysis disequilibrium syndrome (DDS), which might have been amplified by subclinical brain injury due to past chemotherapy. Her history of cancer chemotherapy may be a risk factor for an exacerbation of DDS.
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  • Boudhayan Das Munshi, Sarbani Sengupta, Abhijeet Sharan, Sarmishtha Mu ...
    2015 Volume 54 Issue 21 Pages 2759-2763
    Published: 2015
    Released: November 01, 2015
    JOURNALS OPEN ACCESS
    Pulmonary renal syndrome (PRS) is characterized by both diffuse alveolar haemorrhage and glomerulonephritis as pathological features. Several immunologic and non-immunologic mechanisms including anti-neutrophil cytoplasmic antibody (ANCA)-positive vasculitis, anti-glomerular basement membrane disease, and systemic lupus erythematosus are commonly involved in the pathogenesis of the syndrome. We herein present a 60-year-old woman, non-smoker, who presented with fever, polyarthralgia, and the spreading of generalized purpuric rashes. The patient displayed rapid deterioration over the following two weeks marked by progressive declining renal function followed by haemoptysis. The patient was subsequently diagnosed with PRS, which was confirmed by the radiological evidence of alveolar haemorrhage and the histopathological evidence of pauci-immune glomerulonephritis. All immune markers including ANCA were negative. The patient was successfully treated with hemodialysis and immunosuppressive therapy. ANCA-negative vasculitis is a rare entity and even more rare as an etiology of PRS. An early diagnosis of this disease and its timely intervention is crucial.
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  • Yoshio Okano, Shiomi Yoshida, Tsutomu Shinohara, Naoki Takahashi, Nobu ...
    2015 Volume 54 Issue 21 Pages 2765-2768
    Published: 2015
    Released: November 01, 2015
    JOURNALS OPEN ACCESS
    A case of primary gingival tuberculosis in a 71-year-old Japanese woman is herein presented. A serous saliva culture was positive for tuberculosis, and we recognized that the origin of the tuberculosis infection was the gingiva based on the genetic identification in gingival biopsy tissue. The definitive diagnosis was facilitated by the genetic identification, a useful modern tool for diagnosing infectious diseases. The location and clinical presentation of this lesion were unusual, which underlines the importance of considering tuberculosis in the differential diagnosis of oral lesions that affect the gingiva.
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  • Hideharu Hagiya, Kentaro Deguchi, Kiyohiro Kawada, Fumio Otsuka
    2015 Volume 54 Issue 21 Pages 2769-2773
    Published: 2015
    Released: November 01, 2015
    JOURNALS OPEN ACCESS
    We herein report a heterosexual Japanese man in his forties who had been suffering from advanced dementia and personality change for 4 years. Positive results of a serological test for syphilis, Treponema pallidum hemagglutination assay, and fluorescent treponemal antibody-absorption test of both serum and cerebral spinal fluid led to the diagnosis of neurosyphilis. Jarisch-Herxheimer reaction was seen shortly after the first dose of penicillin was administered to the patient. His cognitive function did not recover after treatment. The incidence of syphilis has been reported to be increasing. Neurosyphilis should not be overlooked as an etiology for progressive dementia even in this post-antibiotic era.
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  • Hideharu Hagiya, Hiroko Ogawa, Yusuke Takahashi, Kosuke Kimura, Kan Ha ...
    2015 Volume 54 Issue 21 Pages 2775-2777
    Published: 2015
    Released: November 01, 2015
    JOURNALS OPEN ACCESS
    We herein present a rare case of Actinomyces turicensis bacteremia that was caused by pyometra. The patient was successfully treated with transvaginal drainage and antibiotic therapy. A literature review in MEDLINE showed that there have been only 8 previously reported cases of A. turicensis bacteremia. This infection frequently occurs in patients with visceral abscesses, and blood culture examinations usually reveal a polymicrobial pattern. However, the prognosis of such patients has been reported to generally be benign. Due to difficulties in performing bacterial identification and the wide-spectrum clinical pictures associated with this bacteremia, no comprehensive understanding of the clinical features of each Actinomyces species has yet been established.
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