Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
Volume 56 , Issue 10
Showing 1-31 articles out of 31 articles from the selected issue
  • Yoshikazu Kinoshita, Michio Hongo, Motoyasu Kusano, Yoshinori Furuhata ...
    2017 Volume 56 Issue 10 Pages 1131-1139
    Published: May 15, 2017
    Released: May 15, 2017

    Objective To investigate the effect of twice-daily rabeprazole doses on health-related quality of life in refractory patients.

    Methods and Patients Reflux esophagitis patients with an insufficient response to once-daily proton pump inhibitor therapy (Los Angeles Classification grade A-D) received rabeprazole 10 mg or 20 mg twice daily for 8 weeks. The health-related quality of life (SF-8™) and symptoms, using the Frequency Scale for the Symptoms of Gastroesophageal reflux disease, were evaluated before treatment and at weeks 4 and 8. Endoscopy was performed at baseline and at weeks 8 and 32 where possible. The rabeprazole dose was determined by the attending physician.

    Results There were 1,796 patients analyzed for the efficacy of the twice-daily treatment. Of these cases, 1,462 were treated with rabeprazole 10 mg twice daily, and 334 were treated with rabeprazole 20 mg twice daily. The factors that affected the selection of the twice-daily rabeprazole dose by physicians were evaluated, and as expected, "endoscopic findings when treatment was started" had a strong effect on the selection of the rabeprazole dose. With both regimens, health-related quality of life and subjective symptoms were significantly improved at weeks 4 and 8 compared to baseline (p<0.001). The recurrence rate of erosive esophagitis at week 32 was 9.7% in rabeprazole twice daily-treated patients and 28.4% in proton pump inhibitor (PPI) once daily-treated patients. Both regimens were well tolerated.

    Conclusion Twice-daily treatment with rabeprazole improved the subjective symptoms and health-related quality of life in patients with refractory reflux esophagitis more effectively than the standard once-daily dose.

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  • Satoshi Ikegame, Takako Nakano, Junji Otsuka, Michihiro Yoshimi, Tatsu ...
    2017 Volume 56 Issue 10 Pages 1141-1146
    Published: May 15, 2017
    Released: May 15, 2017

    Objective A previously developed sputum antigen detection kit for Streptococcus pneumoniae enabled the early diagnosis of pneumococcal pneumonia using sputum samples. We conducted a prospective study to compare the sensitivity of the sputum and urinary antigen kits.

    Methods Pneumonia patients who were treated from April 2014 to September 2015 were recruited for the present study. Patients with pneumococcal pneumonia who could not participate in the prospective arm of the study were analyzed in the retrospective arm.

    Results Nine of the 69 participants in the prospective study had pneumococcal pneumonia. The sputum antigen kit results correlated well with the sputum culture results. The sensitivity of the sputum antigen kit was 88.9% (8/9), which was higher than that of the urinary antigen kit (5/9; 55.6%). When patients from the retrospective arm of the study were included, the sensitivity of the sputum culture was 93.5% (29/31), which was significantly higher than that of the urinary antigen kit (19/31; 60.6%). False positives were obtained using the sputum antigen kit in four cases. Three of the four false positives were suspected to have resulted from the administration of antibiotics prior to the use of the kit; the remaining case likely occurred due to a false reaction to S. milleri-induced pyothorax.

    Conclusion Collectively, our findings suggest that the sputum antigen kit has a higher sensitivity for detecting S. pneumoniae than the urinary antigen kit. However, the prior administration of antibiotics can render the sputum culture results negative or lead to a false-positive result.

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  • Keigo Ikeda, Kozo Watanabe, Takuya Hirai, Kana Tanji, Tomoko Miyashita ...
    2017 Volume 56 Issue 10 Pages 1147-1152
    Published: May 15, 2017
    Released: May 15, 2017

    Objective The objective of this study was to confirm the efficacy of low-dose mizoribine (MZR), an inhibitor of inosine monophosphate dehydrogenase, as part of synchronized methotrexate (MTX) therapy for rheumatoid arthritis (RA) patients with an inadequate response to various combination therapies of MTX, other synthetic disease-modifying anti-rheumatic drugs (DMARDs) and biological DMARDs.

    Methods Low-dose MZR was administered to 56 uncontrolled RA patients being treated with MTX and various biological DMARDs. The observation period was 12 months, and the disease activity was evaluated based on the Disease Activity Score in 28 joints (DAS28)-ESR, Simplified Disease Activity Index (SDAI) and serum MMP-3 level.

    Results All of the disease activity indices were significantly improved within three months, and the serum MMP-3 levels were also significantly decreased around four months after starting low-dose MZR therapy. No patients experienced any adverse effects.

    Conclusion The present preliminary findings suggest that low-dose MZR therapy with MTX should be considered for the treatment of RA patients with an inadequate response to various combination therapies including MTX, other synthetic DMARDs and biological DMARDs or in whom increasing the dose of MTX is difficult for reasons such as adverse effects and complications.

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