Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
Volume 55 , Issue 9
Showing 1-42 articles out of 42 articles from the selected issue
EDITORIAL
ORIGINAL ARTICLES
  • Erdem Koçak, Erdem Akbal, Seyfettin Köklü, Bilal Erg& ...
    2016 Volume 55 Issue 9 Pages 1043-1048
    Published: 2016
    Released: May 01, 2016
    JOURNALS OPEN ACCESS
    Objective Irritable bowel syndrome (IBS) is a highly prevalent and debilitating functional disorder. The toll-like receptors (TLRs) are a family of pathogen-recognition receptors in the innate immune system. In the present study we aimed to investigate the TLR2, TLR4 and nitric oxide (NO) levels in patients with IBS.
    Methods Fifty-one IBS patients and 15 healthy controls were included in the present study. Colonic tissue levels of TLR2, TLR4 and NO were detected using an enzyme-linked immunosorbent assays (ELISA) and through biochemical methods.
    Results The colonic tissue levels of TLR4 and NO were significantly higher in IBS patients than in healthy controls. A subgroup analysis, which was based on the presence of diarrhea and constipation, showed that TLR2 levels were significantly higher among individuals with diarrhea-predominant IBS than among constipation-predominant IBS patients and healthy controls. The TLR4 levels were significantly higher in the diarrhea-predominant IBS patients and constipation-predominant IBS patients than in comparison healthy controls. The colonic tissue levels of NO were higher in the constipation-predominant IBS patients than in the diarrhea-predominant IBS patients and healthy controls.
    Conclusion In the present study we found that the colonic tissue levels of TLR and NO were elevated in IBS patients. Our results support the presence of a degree of immune dysregulation and oxidative stress in patients with IBS.
    Download PDF (758K)
  • Hisamitsu Miyaaki, Tatsuki Ichikawa, Naota Taura, Satoshi Miuma, Takuy ...
    2016 Volume 55 Issue 9 Pages 1049-1054
    Published: 2016
    Released: May 01, 2016
    JOURNALS OPEN ACCESS
    Objective Hyperinsulinemia plays an important role in the pathophysiological processes of chronic hepatitis C (CHC) and non-alcoholic fatty liver disease (NAFLD). However, there are few reports on hepatic insulin clearance in patients with these diseases.
    Methods A total of 74 CHC patients and 37 NAFLD patients were enrolled in this study. We evaluated their hepatic insulin clearance, insulin sensitivity and β-cell function with an oral glucose tolerance test.
    Results Hepatic insulin clearance in the patients with CHC was significantly correlated with platelets (r=0.271, p=0.020) and liver fibrosis (r=-0.234, p=0.045) and was significantly affected by both steatosis (mild: 0.157±0.078, severe: 0.114±0.053, p=0.024) and fibrosis (mild: 0.167±0.0857, severe: 0.125±0.052, p=0.010). There were no significant differences in (homeostasis model assessment) HOMA-β among steatosis and fibrosis stages. In the NAFLD patients, those with severe fibrosis had significantly reduced hepatic insulin clearance (mild: 0.135±0.045, severe: 0.098±0.031, p=0.013) and significantly increased HOMA-β (mild: 115.6±67.1, severe: 172.8±65.7, p=0.018) compared with the patients with mild fibrosis.
    Conclusion Liver fibrosis development is associated with hepatic insulin clearance in both the CHC and NAFLD patients.
    Download PDF (362K)
  • Lin Li, Xueyao Yin, Dan Yu, Hong Li
    2016 Volume 55 Issue 9 Pages 1055-1060
    Published: 2016
    Released: May 01, 2016
    JOURNALS OPEN ACCESS
    Objective The aim of this study was to evaluate the relationship of various intensities of physical activity with glycemic control and insulin resistance in eastern China.
    Methods A population-based, cross-sectional study was conducted in eastern China. The subjects included 604 community-dwelling people. The participants were classified as insufficiently active (IA); sufficiently active (SA) and very active (VA) according to the International Physical Activity Questionnaire (IPAQ). Insulin sensitivity was assessed using the homeostasis model assessment of insulin resistance (HOMA-IR). Related social, biological, lifestyle factors and clinical characteristics were recorded and used as potential confounders.
    Results The cohort of 604 type 2 diabetes patients were classified according to the activity level: 107 subjects who were classified as IA, 329 met the criteria for SA, and the rest were VA. The proportion of obese patients, smokers, patients with hypertension, and the body weight, body mass index (BMI), waist circumference, hemoglobin A1c protein (HbA1c), and 2-h postprandial blood glucose (2hPG) were significantly lower in the SA and VA groups than in the IA group (p<0.05 or 0.01). The SA group had lower levels of fasting blood glucose (FPG) and HOMA-IR than the IA and VA groups (p<0.05 or 0.01). HOMA-IR was positively correlated with FPG, 2hPG, HbA1c, waist circumference and BMI. HOMA-IR was negatively correlated with the total walking activity (p<0.05). After adjusting for FPG, 2hPG, HbA1c, waist circumference and BMI among the groups, a partial correlation analysis showed a correlation between HOMA-IR and the total walking activity.
    Conclusion Physical activity is a significant factor regarding glycemic control and insulin sensitivity, although SA and walking may be superior to VA for ameliorating insulin sensitivity.
    Download PDF (152K)
  • Hyung Koo Kang, Sang-Won Um, Byeong-Ho Jeong, Kyung Jong Lee, Hojoong ...
    2016 Volume 55 Issue 9 Pages 1061-1066
    Published: 2016
    Released: May 01, 2016
    JOURNALS OPEN ACCESS
    Objective Most small-cell lung cancers (SCLCs) are located within the central aspect of the chest and manifest as a mediastinal or hilar lymphadenopathy. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) makes it possible to perform mediastinal and hilar nodal examinations. The purpose of this study was to evaluate the performance of EBUS-TBNA in the diagnosis of SCLC.
    Methods The diagnostic performances of EBUS-TBNA and/or transesophageal bronchoscopic ultrasound-guided fine-needle aspiration (EUS-FNA-B/E) were calculated using the standard definitions.
    Patients The study consisted of a retrospective review of the medical records for all patients with histologically proven SCLC who previously underwent EBUS-TBNA and/or EUS-FNA-B/E from May 2009 to September 2014.
    Results The analysis was based on 161 patients and 299 aspirated specimens. The patient group included 144 males (89%); the median age was 66 years. EBUS-TBNA and/or EUS-FNA-B/E were performed in 239 mediastinal nodes, 39 hilar/interlobar nodes, and 21 lung parenchymal lesions. The median short diameter of the biopsied lesions was 17 mm. The overall sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of EBUS-TBNA and/or EUS-FNA-B/E on a per-person basis were 97.4%, 100%, 60%, 100%, and 97.5%, respectively. The corresponding values on a per-lesion basis were 91.8%, 100%, 73.0%, 100%, and 93.3%, respectively. There were no serious complications related to EBUS-TBNA.
    Conclusion In our series of patients with SCLC, EBUS-TBNA had an excellent diagnostic yield in the evaluation of mediastinal, hilar and lung parenchymal lesions. Thus, EBUS-TBNA could be a useful and safe diagnostic method with which to evaluate patients with SCLC.
    Download PDF (207K)
  • Takashi Ishiguro, Noboru Takayanagi, Yuri Baba, Yotaro Takaku, Naho Ka ...
    2016 Volume 55 Issue 9 Pages 1067-1070
    Published: 2016
    Released: May 01, 2016
    JOURNALS OPEN ACCESS
    Objective The frequency of pulmonary nontuberculous mycobacteriosis (pNTM), chronic lower respiratory tract infections (cLRTIs), and pneumonia in patients with allergic bronchopulmonary mycosis (ABPM) without cystic fibrosis has not yet been fully investigated.
    Methods We retrospectively analyzed 42 patients with ABPM focusing on the frequency of pNTM and cLRTIs, acute exacerbation of cLRTIs, and pneumonia.
    Results During a median follow-up period of 2,299 days (range, 118-6,138 days), 7 patients developed pNTM (mainly Mycobacterium avium complex), and 21 patients developed cLRTI (mostly from Staphylococcus aureus followed by Pseudomonas aeruginosa). Twelve patients developed 21 episodes of acute exacerbation of cLRTIs, and 4 patients developed pneumonia.
    Conclusion Patients with ABPM can have concomitant NTM infection and, not uncommonly, cLRTI, and they can also sometimes develop pneumonia or an acute exacerbation of cLRTI.
    Download PDF (148K)
  • Nobutaka Inoue, Kazunori Otsui, Takayuki Yoshioka, Atsushi Suzuki, Tor ...
    2016 Volume 55 Issue 9 Pages 1071-1075
    Published: 2016
    Released: May 01, 2016
    JOURNALS OPEN ACCESS
    Objective Karoshi, which is the Japanese term for death from over-work, is usually the extreme result of cardiovascular diseases, and occupational stress plays a pivotal role in the pathogenesis. Depression is closely associated with atherosclerotic cardiovascular disease. The present study was undertaken to examine the relationship between occupational stress and depression.
    Methods We enrolled 231 consecutive outpatients with lifestyle-related diseases such as diabetes, hyperlipidemia and hypertension were enrolled. Occupational stress was measured by qualitative constructs assessing job control, job demands, and worksite social support using a job content questionnaire (JCQ). The job strain index measured by the ratio of job demands to job control was used as an indicator of the occupational stress. Depression was evaluated by the Self-rating Depression Scale (SDS).
    Results A univariate linear regression analysis showed the SDS scores to be positively correlated with job demands and the job strain index and negatively correlated with job control and worksite social support. Multiple regression analyses to predict the SDS scores demonstrated that job demands were positively associated with SDS scores and job control and worksite social support were negatively associated with SDS scores after controlling for other variables. The job strain index was positively related to SDS scores.
    Conclusion Occupational stress expressed as the job strain index was strongly associated with depression. By simultaneously using the SDS and JCQ, the health conditions of patients could be classified based on occupational stress and mental stress, and this classification could help to promote a healthy work environment and guide individual workers.
    Download PDF (175K)
  • Masakuni Sakaguchi, Toshiya Maebayashi, Takuya Aizawa, Naoya Ishibashi ...
    2016 Volume 55 Issue 9 Pages 1077-1083
    Published: 2016
    Released: May 01, 2016
    JOURNALS OPEN ACCESS
    Objective In recent years, an increase has been observed in the incidence of bone metastases from hepatocellular carcinoma (HCC). In 2007, our institution established a team approach, which includes the provision of palliative care. In the present study we evaluate the effects of palliative care on the prognosis of HCC patients with bone metastases.
    Methods The subjects included 44 patients with bone metastases who were treated with radiotherapy between 2000 and 2014. The subjects were divided into groups that received radiotherapy from 2000 to 2006 and after 2007. The overall survival rates after radiotherapy were analyzed.
    Results The median survival time of the patients who received care between 2007 and 2014 was 6 months, which was significantly longer than that in the patients who received care between 2000 and 2006.
    Conclusion The present team approach in our hospital, which includes the provision of palliative care, started in 2007. This approach may have improved prognosis of patients with metastatic HCC.
    Download PDF (366K)
CASE REPORTS
  • Lei Lu, Xiao-Feng Zhang
    2016 Volume 55 Issue 9 Pages 1085-1089
    Published: 2016
    Released: May 01, 2016
    JOURNALS OPEN ACCESS
    Gastric bezoars are concretions of undigested material, and Coca-Cola therapy is an easy, efficacious and safe approach for bezoar treatment. Gastric outlet obstruction due to a migratory gastric bezoar during Coca-Cola therapy is an uncommon presentation and, to the best of our knowledge, no cases have been previously reported. We herein describe one such case with no known predisposing factors that recovered via the endoscopic technique. A thorough literature search was performed, which yielded eight relevant patients from seven publications, all of who developed gastrointestinal obstruction during dissolution treatment and recovered uneventfully after surgical intervention. In conclusion, this potential complication should be kept in mind in the event that alternative treatment is necessary.
    Download PDF (515K)
  • Keisuke Kakisaka, Hidekatsu Kuroda, Tamami Abe, Yuji Suzuki, Yuichi Yo ...
    2016 Volume 55 Issue 9 Pages 1091-1095
    Published: 2016
    Released: May 01, 2016
    JOURNALS OPEN ACCESS
    A 52-year-old Japanese woman admitted to our hospital for the treatment of liver dysfunction due to an undetermined cause developed disorientation on the 58th hospital day and was diagnosed with late-onset liver failure. Abdominal ultrasound examinations were performed several times from the admission. Before the disorientation appeared, the results of the examinations revealed that the portal flow decreased, after which the hepatic arterial flow increased and the degree of liver stiffness became elevated. Although the pathophysiology of these changes remains unclear, hemodynamic changes and elevation of liver stiffness might be predictive markers of severe liver tissue damage.
    Download PDF (1682K)
  • Tetsuya Takikawa, Atsushi Kanno, Atsushi Masamune, Seiji Hongo, Naoki ...
    2016 Volume 55 Issue 9 Pages 1097-1102
    Published: 2016
    Released: May 01, 2016
    JOURNALS OPEN ACCESS
    A 32-year-old woman was referred due to abdominal pain and elevated liver enzymes. Computed tomography and magnetic resonance imaging showed ectopic opening of the common bile duct (CBD) into the duodenal bulb. Esophagogastroduodenoscopy showed a hemispheric bulge in the duodenal bulb. Endoscopic retrograde cholangiopancreatography (ERCP) revealed the bulge to be cystic dilatation of the CBD. ERCP also showed no communication between the ventral and dorsal pancreatic ducts. We diagnosed the patient with ectopic opening of the CBD accompanied by choledochocele and pancreas divisum. Endoscopic incision was performed for the treatment of the choledochocele. The patient's symptoms and elevated liver enzymes improved after treatment.
    Download PDF (915K)
  • Shu Yoshihara, Masaki Matsunaga, Taku Yaegashi, Shioto Suzuki, Masaaki ...
    2016 Volume 55 Issue 9 Pages 1103-1108
    Published: 2016
    Released: May 01, 2016
    JOURNALS OPEN ACCESS
    Left ventricular (LV) involvement in the advanced stage of arrhythmogenic right ventricular cardiomyopathy (ARVC) is a well recognized phenomenon. T wave inversion in the lateral leads has been reported to be an electrocardiographic marker of LV involvement. Variants of ARVC that preferentially affect the left ventricle (left-dominant subtype of arrhythmogenic cardiomyopathy) have recently been recognized. We herein report a case in which an initial electrocardiogram that was similar to the left-dominant subtype of arrhythmogenic cardiomyopathy progressed to definitive ARVC over a period of 7 years. This case supports the hypothesis that LV involvement in ARVC may precede the evident onset of significant RV dysfunction.
    Download PDF (2598K)
  • Seijiro Shimada, Shunji Maekura, Hikaru Ino, Masayosi Matsuura, Nobuta ...
    2016 Volume 55 Issue 9 Pages 1109-1115
    Published: 2016
    Released: May 01, 2016
    JOURNALS OPEN ACCESS
    Amyloidosis is a well-known but uncommon disease, and the physician must maintain a high index of suspicion in order to make a timely diagnosis. The expected survival of patients with cardiac amyloidosis is generally poor. In particular, survival has been reported to be 4-12 months for patients with amyloid light-chain amyloidosis with congestive heart failure. We herein report a rare case of cardiac amyloidosis in which the patient presented with cardiac hypertrophy after a 20-year history of dilated cardiomyopathy and heart failure.
    Download PDF (1982K)
  • Tetsuma Kawaji, Satoshi Shizuta, Takeru Makiyama, Takeshi Kimura
    2016 Volume 55 Issue 9 Pages 1117-1120
    Published: 2016
    Released: May 01, 2016
    JOURNALS OPEN ACCESS
    Having a relative with atrial fibrillation (AF) is one of the risk factors for AF development, especially in young patients, which is known as familial AF. Although familial AF is considered to be associated with inherited factors, its genetic and pathophysiological backgrounds have not been fully identified. We report two young brothers undergoing radiofrequency catheter ablation for AF, who had a huge left atrial appendage (LAA). In both cases, the origins of the main triggers of the AF were not the huge LAA itself, but left pulmonary veins compressed by the LAA. Since catheter ablation including pulmonary vein isolation, the sinus rhythm has been maintained in both patients.
    Download PDF (1274K)
  • Keisuke Shioji, Takashi Kurita, Takafumi Kawai, Takashi Uegaito, Koich ...
    2016 Volume 55 Issue 9 Pages 1121-1124
    Published: 2016
    Released: May 01, 2016
    JOURNALS OPEN ACCESS
    We herein describe an adult case of double-chambered right ventricle (DCRV) with symptomatic drug-intolerant paroxysmal atrial fibrillation (PAf). The woman was referred to undergo radiofrequency ablation (RFA), and mapping of the pulmonary veins (PVs) demonstrated that a spontaneous spike potential originating from the left inferior PV (LIPV) induced sustained Af in the second procedure. Accordingly, the LIPV was regarded as the arrhythmogenic PV. Since complete isolation of the PVs, the sinus rhythm has been maintained for at least two years. This is the first report to describe that RFA for drug-intolerant PAf was useful in a patient with DCRV.
    Download PDF (765K)
  • Keiichi Torimoto, Yosuke Okada, Hiroko Mori, Yoshiya Tanaka
    2016 Volume 55 Issue 9 Pages 1125-1129
    Published: 2016
    Released: May 01, 2016
    JOURNALS OPEN ACCESS
    The older of a pair of sisters experienced hypoglycemia after the start of thiamazole (MMI) treatment. Based on a high insulin antibody level, she was diagnosed with insulin autoimmune syndrome (IAS). HLA-DNA typing identified DRB1*04:06. Although a 75-g oral glucose tolerance test (OGTT) showed biphasic insulin secretion, the secretion pattern became monophasic after discontinuation of the MMI. The younger sister was diagnosed with IAS after the start of MMI treatment. HLA-DNA typing identified DRB1*04:06. The 75-g OGTT showed biphasic insulin secretion, but it became monophasic after discontinuation of the MMI. According to the similar insulin secretion kinetics in the two sisters with IAS, we suspect that a genetic predisposition may be associated with the features of anti-insulin antibodies.
    Download PDF (282K)
  • Toru Suzuki, Shojiro Sawada, Yasushi Ishigaki, Sohei Tsukita, Shinjiro ...
    2016 Volume 55 Issue 9 Pages 1131-1136
    Published: 2016
    Released: May 01, 2016
    JOURNALS OPEN ACCESS
    Lipoprotein lipase (LPL) deficiency is a rare monogenic disorder that manifests as severe hypertriglyceridemia. Whether or not LPL deficiency accelerates the development of atherosclerosis remains controversial. We herein report a 66-year-old woman who was homozygous for the R243H LPL mutation. She had developed multiple arterial aneurysms and systemic atherosclerosis despite good control of other atherogenic risk factors, including diabetes. Furthermore, although intensive pharmaceutical therapies had been minimally effective, medium chain triglyceride (MCT) therapy reduced the serum triglyceride levels. Thus, this case suggests important role that mutated LPL protein plays in the progression of atherosclerosis and that MCT therapy is potentially effective, even for severe hypertriglyceridemia due to LPL deficiency.
    Download PDF (508K)
  • Sachie Hirose, Yasuyuki Iwahashi, Akane Seo, Michitaka Sumiyoshi, Tets ...
    2016 Volume 55 Issue 9 Pages 1137-1142
    Published: 2016
    Released: May 01, 2016
    JOURNALS OPEN ACCESS
    Reactive hypoglycemia induced by late dumping syndrome is often observed after gastrectomy. However, no effective therapy has yet been fully established. We herein describe a case in which concurrent therapy with a low-carbohydrate diet using low-glycemic-index food and an alpha-glucosidase inhibitor, miglitol, very effectively ameliorated the postprandial fluctuations in the blood glucose and plasma insulin levels in a patient with reactive hypoglycemia due to late dumping syndrome following total gastrectomy. The administration of miglitol under a low-carbohydrate diet using low-glycemic-index food may therefore be an ideal treatment for reactive hypoglycemia due to late dumping syndrome.
    Download PDF (337K)
  • Hiroyo Ninomiya, Ayumu Hirata, Junji Kozawa, Shinsuke Nakata, Takekazu ...
    2016 Volume 55 Issue 9 Pages 1143-1147
    Published: 2016
    Released: May 01, 2016
    JOURNALS OPEN ACCESS
    The 3243 A>G mutation in mitochondrial DNA is the most common cause of monogenic diabetes mellitus in Japan. A 45-year-old woman with mitochondrial diabetes and significant insulin resistance presented with hypoadiponectinemia despite a normal amount of visceral fat. Three months of treatment with pioglitazone (PIO) improved her blood glucose profile and response to the 75-g oral glucose tolerance test. These changes were accompanied by the amelioration of her insulin resistance and the impairment of early-phase insulin secretion. Her serum adiponectin levels increased to the normal range. In this case of mitochondrial diabetes, PIO was effective for glycemic control.
    Download PDF (175K)
  • Akihiro Ryuge, Hideaki Shimizu, Yukako Ohyama, Makoto Yamaguchi, Atsus ...
    2016 Volume 55 Issue 9 Pages 1149-1151
    Published: 2016
    Released: May 01, 2016
    JOURNALS OPEN ACCESS
    Diltiazem overdose has a high mortality rate due to cardiotoxicity associated with bradycardia and hypotension. A previous article reported that this type of overdose can cause acute tubular necrosis, which was not pathologically, but rather clinically, diagnosed. We herein report the case of a 55-year-old man who sustained nonoliguric acute kidney injury after taking 60 diltiazem tablets. A kidney biopsy performed six days after admission showed ischemic, not toxic, acute tubular necrosis. The patient's kidney function improved spontaneously. In this case report, we clarify the cause of renal impairment caused by diltiazem overdose pathologically. Physicians should therefore consider ischemic acute tubular necrosis as a cause of kidney injury in patients with diltiazem overdose.
    Download PDF (333K)
  • Takashi Maruyama, Masanori Abe, Tetsuya Furukawa, Shinichiro Kobayashi ...
    2016 Volume 55 Issue 9 Pages 1153-1158
    Published: 2016
    Released: May 01, 2016
    JOURNALS OPEN ACCESS
    A 73-year-old man with chronic kidney disease stage G5 was admitted to our hospital because of a worsening kidney dysfunction. He had undergone prosthetic valve replacement of the mitral valve 5 years previously and was currently taking warfarin. He showed excessive anticoagulation on admission, with a prothrombin time-international normalized ratio (PT-INR) of 3.91. The use of warfarin was ceased and PT-INR decreased to 2.1. Since the patient would need renal replacement therapy, he underwent arteriovenous fistula surgery for hemodialysis access on day 16. However, on day 18, he suddenly complained of lumbago and went into shock. His blood pressure dropped to 73/49 mmHg, and the hemoglobin level fell to 4.9 g/dL. Computed tomography revealed a huge retroperitoneal hematoma. Emergent lumbar artery embolization was performed on two consecutive days; however, the bleeding persisted, with subsequent development of abdominal compartment syndrome with impaired respiratory and cardiovascular function, and the patient died. Autopsy revealed a hematoma measuring 30×20×20 cm involving the psoas muscle and external iliac artery; the hematoma was covered with fibrous tissue instead of muscle. The psoas muscle is supplied by the internal iliac artery; however, a collapsed artery could not be confirmed in our patient. The closest major artery to the hematoma was located at the intersection of the psoas muscle and the external iliac artery. All arteries showed severe atherosclerosis. In patients with advanced chronic kidney disease, anticoagulant therapy should be administered carefully, and the etiology of retroperitoneal hematoma should be further investigated.
    Download PDF (2306K)
  • Tetsuro Sawata, Masashi Bando, Haruna Kogawara, Masayuki Nakayama, Nao ...
    2016 Volume 55 Issue 9 Pages 1159-1163
    Published: 2016
    Released: May 01, 2016
    JOURNALS OPEN ACCESS
    A 51-year-old woman diagnosed with Crohn's disease developed drug-induced hypersensitivity syndrome (DIHS) 12 and six weeks after starting the oral intake of mesalazine and trimethoprim/sulfamethoxazole, respectively. Chest CT showed centrilobular nodular shadows and a transbronchial lung biopsy (TBLB) revealed infiltration of inflammatory cells predominantly in the small pulmonary artery walls and bronchiolar walls. Regarding pulmonary lesions of DIHS, infiltrative shadows have sometimes been reported, whereas nodular shadows have rarely been documented. This is a valuable case report for considering the mechanism underlying the development of pulmonary lesions in case of DIHS.
    Download PDF (4737K)
  • Soo Yoon Moon, Hee Su Park, Ji Young Woo, Jae Kyun Choi, HaeMi Oh, Kyu ...
    2016 Volume 55 Issue 9 Pages 1165-1169
    Published: 2016
    Released: May 01, 2016
    JOURNALS OPEN ACCESS
    A 48-year-old woman was referred to our clinic because she had been experiencing hemoptysis for 1 month. Chest computed tomography revealed a small portion of a thyroid mass was penetrating the trachea. Bronchoscopy revealed a blood vessel covered mass located in her trachea. The presence of a malignant tumor was confirmed by a biopsy. The patient was referred to the otolaryngology department for tumor resection and a pathological evaluation identified the thyroid angiosarcoma with tracheal invasion. Angiosarcomas have a poor prognosis, but the patient has not experienced any recurrence two years after surgery. A very rare case of primary thyroid angiosarcoma with tracheal invasion was cured successfully.
    Download PDF (1969K)
  • Shunichiro Yasuda, Masahide Yamamoto, Tetsuya Fukuda, Yasufumi Ohtsuka ...
    2016 Volume 55 Issue 9 Pages 1171-1175
    Published: 2016
    Released: May 01, 2016
    JOURNALS OPEN ACCESS
    Atypical hemolytic uremic syndrome (aHUS) is a rare type of HUS associated with dysregulation of the alternative complement pathway. We herein report the findings of a 43-year-old woman who developed aHUS two days after myomectomy. The serum C3 level was low and the sheep erythrocyte hemolytic assay showed a moderate hemolysis. The renal insufficiency progressed despite performing plasma exchange therapy, although a partial hematological response was observed. Thus, the patient was subsequently treated with the anti-C5 antibody eculizumab, which promptly improved and normalized the renal function. Although aHUS after surgery has rarely been reported, it needs to be promptly recognized and treated with eculizumab to prevent irreversible renal damage.
    Download PDF (245K)
  • Hiroyuki Takata, Taichi Ikebe, Hitohiro Sasaki, Yasuhiko Miyazaki, Eii ...
    2016 Volume 55 Issue 9 Pages 1177-1181
    Published: 2016
    Released: May 01, 2016
    JOURNALS OPEN ACCESS
    Philadelphia chromosome positive (Ph+) mixed phenotype acute leukemia (MPAL) is a rare type of acute leukemia having both myeloid and lymphoid features for which no optimal treatment has yet been established. We herein describe two elderly Ph+MPAL patients who achieved molecular remission without any serious adverse events by treatment with dasatinib and prednisolone. Although dasatinib induction therapy combined with prednisolone is known to be a highly effective treatment for Ph+ acute lymphoblastic leukemia, its efficacy for Ph+MPAL has not been shown. The clinical courses of the present cases suggest that combination therapy with dasatinib and prednisolone is a safe and effective therapeutic modality in elderly Ph+MPAL patients.
    Download PDF (697K)
  • Shinsuke Mizutani, Junya Kuroda, Nana Sasaki, Miki Kiyota, Shotaro Tat ...
    2016 Volume 55 Issue 9 Pages 1183-1186
    Published: 2016
    Released: May 01, 2016
    JOURNALS OPEN ACCESS
    We report the case of a 72-year-old man who presented with non-producing multiple myeloma (MM) with three additional concomitant solid tumors that were identified by postmortem autopsy. The disease was refractory to anti-MM therapy including bortezomib and lenalidomide, and he finally died of bacterial pneumonia with diffuse alveolar damage 8 months after the diagnosis. An autopsy revealed that he was also affected by three other solid cancers, cholangiocellular carcinoma, medullary thyroid cancer and papillary thyroid cancer that were clinically asymptomatic and remained undiagnosed before death. A review of the literature suggests that primary quadruple cancers including MM are extremely rare.
    Download PDF (741K)
  • Yoichi Ohnuki, Atsushi Mizuma, Tsuyoshi Uesugi, Shunya Takizawa
    2016 Volume 55 Issue 9 Pages 1187-1189
    Published: 2016
    Released: May 01, 2016
    JOURNALS OPEN ACCESS
    A 63-year-old man presented with the loss of the sensations of pain and temperature sensation in the right facial region innervated by the trigeminal nerve (V1 to 3). He showed abnormal lesions in the pons and the trigeminal nerve on magnetic resonance imaging (MRI). He had recurrent herpes in the nasal cavity, and a history of left facial palsy. We herein present the unique MRI findings and suggest that herpes simplex infection may cause trigeminal neuropathy. This is the first reported case of dissociated trigeminal neuropathy with herpes simplex infection which was accompanied by a pontine lesion on MRI.
    Download PDF (1164K)
  • Toru Baba, Shigenori Kanno, Tomomi Shijo, Yoshiyuki Nishio, Osamu Iizu ...
    2016 Volume 55 Issue 9 Pages 1191-1193
    Published: 2016
    Released: May 01, 2016
    JOURNALS OPEN ACCESS
    Relapsing polychondritis (RP) is a rare inflammatory disorder of the cartilagenous structures, and it sometimes involves the central nervous system. Encephalitis associated with RP causes a wide variety of symptoms according to the affected sites. We herein report the first case of 72-year-old right-handed man who developed acute meningoencephalitis associated with RP involving the corpus callous. After immunosuppressive therapy, his symptoms dramatically improved, but difficulty in performing bimanual movements with occasional diagonistic dyspraxia in his right hand remained. Because callosal signs are easily missed, especially in acute settings, it would be useful to know that RP can sometimes cause callosal disconnection syndrome.
    Download PDF (935K)
  • Yuji Nishizaki, Shinichiro Yamagami, Hisashi Inoue, Yuki Uehara, Shige ...
    2016 Volume 55 Issue 9 Pages 1195-1198
    Published: 2016
    Released: May 01, 2016
    JOURNALS OPEN ACCESS
    We report the case of a 58-year-old man presenting with chest pain who underwent percutaneous coronary intervention (PCI). The patient subsequently developed a fever over 38°C, pain on micturition, and cloudy urine 3 days following PCI. Urine cultures were positive for Escherichia coli and Enterococcus faecalis, whereas blood cultures were negative. Arthritis occurred two weeks following urinary tract infection (UTI). We herein present a rare case of reactive arthritis caused by UTI following PCI.
    Download PDF (528K)
  • Shin-ichi Tokushige, Kako Kodama, Takuto Hideyama, Hanae Kumekawa, Jun ...
    2016 Volume 55 Issue 9 Pages 1199-1202
    Published: 2016
    Released: May 01, 2016
    JOURNALS OPEN ACCESS
    A 78-year-old woman with a history of bronchial asthma presented with distal dominant sensory disturbance and weakness in the upper and lower extremities. A biopsy of the left peroneus brevis muscle showed active vasculitis with inflammation extending into muscle fascicles and fibrinoid necrosis of the vessel wall, consistent with eosinophilic granulomatosis with polyangiitis (EGPA). Despite her decreased serum osmolarity, her serum antidiuretic hormone level was not reduced, consistent with the syndrome of inappropriate antidiuretic hormone (SIADH). Intravenous and oral steroid therapy improved her neurological symptoms. Clinicians should consider EGPA as a concurrent, and potentially causative, disorder in cases of SIADH.
    Download PDF (826K)
  • Sho Saito, Ichiro Kawamura, Mika Tsukahara, Keiichi Uemura, Kiyofumi O ...
    2016 Volume 55 Issue 9 Pages 1203-1205
    Published: 2016
    Released: May 01, 2016
    JOURNALS OPEN ACCESS
    Corynebacterium striatum has been described as a pathogen in immunocompromised patients; however, correctly identifying Corynebacterium spp. is often difficult, and cases of cellulitis caused by C. striatum are only rarely reported. We herein describe a case of cellulitis and bacteremia due to C. striatum identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry. Antimicrobial susceptibility testing was performed using the Strepto-Haemo Supplement method, and vancomycin was replaced by a narrow-spectrum oral amoxicillin.
    Download PDF (116K)
  • Kosaku Kinoshita, Tsukasa Kuwana, Satoshi Hori
    2016 Volume 55 Issue 9 Pages 1207-1211
    Published: 2016
    Released: May 01, 2016
    JOURNALS OPEN ACCESS
    Transient heterotopic calcification with unexpected hypercalcemia after septic shock is a very rare phenomenon. We encountered a complicated case in which heterotopic calcification occurred in the liver, bilateral iliopsoas and pubococcygeal muscles after treatment of septic shock and multiple organ failure. Hypercalcemia was not present when the heterotopic calcification was detected by plain CT scans. Physicians who observe acute and progressive heterotopic calcification during sepsis treatment need to recognize the risk of hypercalcemia even if it is not present before the detection of heterotopic calcification. This case provides useful information regarding the critical aspects of heterotopic calcification after sepsis treatment.
    Download PDF (1479K)
  • Tatsuro Hirayama, Takahiro Takazono, Yoshiro Horai, Masato Tashiro, To ...
    2016 Volume 55 Issue 9 Pages 1213-1217
    Published: 2016
    Released: May 01, 2016
    JOURNALS OPEN ACCESS
    A 68-year-old man was admitted to our hospital with anorexia and leg pain. He was diagnosed with ANCA-associated vasculitis through a renal biopsy. Immunosuppression with two courses of steroid pulse therapies and intravenous cyclophosphamide followed by oral prednisolone at 40 mg/day were administered. About one month after starting the immunosuppression therapy, he complained of hemosputum. Chest computed tomography showed a cavitary lesion in the lung. Cultures from his sputum showed Nocardia species, and we were able to identify the species as N. concava using a 16S rRNA gene sequence analysis. Only three detailed reports of N. concava infection have so far been published worldwide.
    Download PDF (1659K)
  • Akihiro Sato, Itaru Nakamura, Hiroaki Fujita, Shinji Fukushima, Yasuta ...
    2016 Volume 55 Issue 9 Pages 1219-1222
    Published: 2016
    Released: May 01, 2016
    JOURNALS OPEN ACCESS
    We report a case of neurocysticercosis concurrent with taeniasis in a 31-year-old woman. The patient presented with a headache and diplopia. Oculomotor disturbances with a left adduction deficit were observed. Fundoscopy revealed papilledema. Additionally, computed tomography of the brain revealed more than 20 small cysts within the parenchyma, most of which were associated with ring enhancement. Moreover, serum antibody testing (Western blotting) for Taenia solium-cysticerci was positive. The patient received albendazole and corticosteroids, and progressive resolution of the neurological symptoms and papilledema was observed starting approximately three days after administration. This patient has been asymptomatic for more than one year.
    Download PDF (1598K)
  • Kentaro Takahashi, Shin-ichiro Kagami, Hirotoshi Kawashima, Daisuke Ka ...
    2016 Volume 55 Issue 9 Pages 1223-1228
    Published: 2016
    Released: May 01, 2016
    JOURNALS OPEN ACCESS
    We herein describe a second Japanese case of sarcoidosis presenting Addison's disease. A 52-year-old man was diagnosed with sarcoidosis based on clinical and laboratory findings, including bilateral hilar lymphadenopathy and elevated levels of serum angiotensin-converting enzyme and lysozyme, as well as the presence of noncaseating epithelioid granulomas. The patient also exhibited general fatigue, pigmentation, weight loss, hypotension and hyponatremia, suggestive of chronic adrenocortical insufficiency. An endocrine examination confirmed primary adrenocortical insufficiency. This case suggests the direct involvement of sarcoid granuloma in the adrenal glands.
    Download PDF (2149K)
  • Mari Yamasue, Shin-ichi Nureki, Ryoichi Ushijima, Yutaka Mukai, Akihik ...
    2016 Volume 55 Issue 9 Pages 1229-1233
    Published: 2016
    Released: May 01, 2016
    JOURNALS OPEN ACCESS
    We herein report a rare case of sarcoidosis presenting as bilateral vocal cord paralysis due to bilateral vagal nerve involvement. A 72-year-old woman with uveitis of the left eye complained of hoarseness and aspiration due to bilateral vocal cord paralysis. An endobronchial needle aspiration biopsy specimen of the mediastinal lymph nodes showed non-caseating epithelioid cell granuloma. Total protein and cell concentrations in the cerebrospinal fluid were increased. We diagnosed her to have sarcoidosis with bilateral vagal nerve involvement. Corticosteroid therapy improved her symptoms of hoarseness and aspiration. Sarcoidosis should therefore be taken into consideration as a potential cause of bilateral vocal cord paralysis.
    Download PDF (1109K)
PICTURES IN CLINICAL MEDICINE
LETTERS TO THE EDITORS
feedback
Top