Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
Volume 56 , Issue 4
Showing 1-20 articles out of 20 articles from the selected issue
ORIGINAL ARTICLES
  • Eiji Yamada, Seitaro Watanabe, Atsushi Nakajima
    2017 Volume 56 Issue 4 Pages 383-388
    Published: February 15, 2017
    Released: February 15, 2017
    JOURNALS OPEN ACCESS

    Objective To clarify the effects of mental health and physical function in association with colonoscopy-related pain.

    Methods The mental health and physical function were evaluated using the Japanese version of the SF-8 Health Survey questionnaire. Poor physical status was defined as a physical component summary (PCS) <40 and poor mental status as a mental component summary (MCS) <40. Pain was assessed using a visual analogue scale (VAS), with significant pain defined as VAS ≥70 mm and insignificant pain as VAS <70 mm. The background and colonoscopic findings were compared in patients with significant and insignificant pain.

    Patients This study evaluated consecutive Japanese patients who were positive on fecal occult blood tests and underwent total colonoscopy.

    Results Of the 100 patients, 23 had significant and 77 had insignificant colonoscopy-related pain. A multiple logistic regression analysis showed that MCS <40 [odds ratio (OR) 6.03; 95% confidence interval (CI) 1.41-25.9, p=0.0156], PCS <40 (OR 5.96; 95% CI 1.45-24.5, p=0.0133), and ≥300 seconds to reach the cecum (OR 4.13; 95% CI 1.16-14.7, p=0.0281) were independent risk factors for colonoscopy-related pain.

    Conclusion The mental health and physical function are important determinants of colonoscopy-related pain. Evaluating the mental health and physical function of patients prior to colonoscopy may effectively predict the degree of colonoscopy-related pain.

    Download PDF (224K)
  • Yoshinori Hashimoto, Takanori Fukuta, Junko Maruyama, Hiromi Omura, Ta ...
    2017 Volume 56 Issue 4 Pages 389-393
    Published: February 15, 2017
    Released: February 15, 2017
    JOURNALS OPEN ACCESS

    Objective Although use of the peripherally inserted central venous catheter (PICC) has become increasingly common, there are few reports of PICCs used for patients with hematologic diseases. In this study, we analyzed the safety of PICC placement in patients with hematologic diseases where PICCs had been placed to perform blood collection, blood transfusion, drug administration, and hematopoietic stem cell transplantation.

    Methods This study included 142 PICCs placed in 95 patients managed at our department from November 2013 to December 2015. The PICCs used were the Groshong® Catheter (NXT single-lumen; BARD Inc.).

    Results A total of 95 patients underwent the placement of 142 PICCs. The mean patient age was 65.5 years. The total duration of catheterization was 8,089 days, with a mean duration of 57.0 days. Chemotherapy was administered through 107 catheters. Stem cells were injected through 12 catheters. Although a fever was observed in association with 103 catheters, it was generally controlled by antimicrobial therapy. There were 18 catheter-related bloodstream infection (CRBSI) cases, an incidence equivalent to 2.1 cases per 1,000 catheter-days.

    Conclusion The present study demonstrated a low CRBSI incidence rate and found no evidence of serious complications with PICC placement. PICCs can be used for blood collection, blood transfusion, drug administration, and hematopoietic stem cell transplantation without problems. Thus, PICC placement appears to be a safe procedure for patients with hematologic diseases. Safe catheters are therefore urgently needed for these patients. We expect that PICCs will be widely adopted in Japan in the near future.

    Download PDF (126K)
CASE REPORTS
  • Miho Sakumura, Kazuto Tajiri, Shigeharu Miwa, Kohei Nagata, Kengo Kawa ...
    2017 Volume 56 Issue 4 Pages 395-400
    Published: February 15, 2017
    Released: February 15, 2017
    JOURNALS OPEN ACCESS

    Hepatic sinusoidal obstruction syndrome (SOS), a serious complication that mainly occurs after hematopoietic-stem cell transplantation (HSCT), is caused by damage to the sinusoidal endothelial cells after the obstruction of the sinusoid. Recently, hepatic SOS was reported to occur after non-HSCT chemotherapies. This report describes a patient who experienced hepatic SOS after non-HSCT chemotherapy for non-Hodgkin lymphoma. A liver biopsy showed the slight dilatation of the hepatic sinusoid, which may be indicative of hepatic SOS. Hepatic SOS should be included in the differential diagnosis of patients with severe liver injury following the administration of chemotherapy regimens that are toxic to the vascular endothelial cells.

    Download PDF (1670K)
  • Kenji Yorita, Shiori Sasaki, Ai Kawada, Michiyo Okazaki, Hiromichi Yam ...
    2017 Volume 56 Issue 4 Pages 401-407
    Published: February 15, 2017
    Released: February 15, 2017
    JOURNALS OPEN ACCESS

    Hepatoid adenocarcinoma (HAC) is a rare subtype of extrahepatic adenocarcinoma that is characterized by its morphological and functional similarities to hepatocellular carcinoma. We herein present a novel case of HAC arising from the extrahepatic bile duct in a 75-year-old Japanese woman with polysplenia syndrome. This is the second reported case of HAC arising from this site. The tumor induced jaundice and hemobilia. A total of four isolated intraductal polypoid masses of HAC were found. No recurrence was seen five months after surgery. Further reports of similar cases will be needed to clarify the clinical characteristics and the prognosis of this malignancy.

    Download PDF (2050K)
  • Daisuke Sueta, Rika Akahoshi, Yoshinori Okamura, Sunao Kojima, Tomokaz ...
    2017 Volume 56 Issue 4 Pages 409-412
    Published: February 15, 2017
    Released: February 15, 2017
    JOURNALS OPEN ACCESS

    A 40-year-old woman experiencing sudden dyspnea went to her personal doctor for advice. She was previously diagnosed with endometriosis and prescribed oral contraceptives for treatment. During earthquakes, she spent 7 nights sleeping in a vehicle. The patient had swelling and pain in her left leg and high D-dimer concentration levels. A contrast-enhanced computed tomography scan revealed a contrast deficit in the bilateral pulmonary artery and in the left lower extremity. She was diagnosed with pulmonary thromboembolism (PTE), and anticoagulation therapy was initiated. This present case is the first report of PTE attributed to the use of oral contraceptives after earthquakes.

    Download PDF (1080K)
  • Ko Harada, Yoshihisa Hanayama, Kou Hasegawa, Masaya Iwamuro, Hideharu ...
    2017 Volume 56 Issue 4 Pages 413-417
    Published: February 15, 2017
    Released: February 15, 2017
    JOURNALS OPEN ACCESS

    Insulinoma is a rare, usually benign, pancreatic neuroendocrine tumor. The clinical features of an insulinoma are fasting hypoglycemia with neuroglycopenic symptoms including confusion and unusual behavior, while hypertension is usually not associated with the disease. We herein report a patient with insulinoma who manifested paroxysmal hypertension and neuroglycopenic symptoms. The possible etiology of hypertension induced by an insulinoma is catecholamine release in response to hypoglycemia, which may cause acute hypertension through activation of the sympatho-adrenal system. This case implies that sustained hyperinsulinemia due to insulinoma can be functionally linked to the induction of paroxysmal hypertension.

    Download PDF (702K)
  • Reiko Inoue, Yoshihide Fujigaki, Kana Kobayashi, Yoshifuru Tamura, Tat ...
    2017 Volume 56 Issue 4 Pages 419-423
    Published: February 15, 2017
    Released: February 15, 2017
    JOURNALS OPEN ACCESS

    We report a 70-year-old woman with Sjögren's syndrome who had severe renal dysfunction with mild proteinuria and elevated urinary low-molecular-weight proteins. Based on these clinical presentations, interstitial nephritis due to Sjögren's syndrome was strongly suspected. Unexpectedly, renal pathology revealed amyloid light-chain (AL) lambda-type depositions predominantly in the vasculatures with severe tubulointerstitial damage. Concentrated urine immunofixation was positive for Bence Jones lambda-type monoclonal proteins. Given the involvement in other organs, systemic AL amyloidosis was diagnosed. The patient underwent chemotherapy, but hemodialysis was ultimately instituted. It should be remembered that renal amyloidosis occurs as a clinical presentation of interstitial nephritis.

    Download PDF (1387K)
  • Hajime Kasai, Jiro Terada, Hiromasa Hoshi, Takashi Urushibara, Fumiaki ...
    2017 Volume 56 Issue 4 Pages 425-428
    Published: February 15, 2017
    Released: February 15, 2017
    JOURNALS OPEN ACCESS

    Diffuse alveolar hemorrhage (DAH) is a life-threatening complication that occurs in association with various diseases including coagulation disorders. In rare cases, it is caused by hemophilia. A 48-year-old man was admitted to our hospital for a third time due to DAH. Although the cause of DAH could not be identified by bronchoscopy or laboratory tests, a good response to corticosteroids suggested idiopathic DAH with pulmonary capillaritis. The patient was diagnosed with hemophilia B based on the results of a detailed inquiry, a mildly prolonged activated partial thromboplastin time, and low factor IX activity. Hemophilia may be an underlying factor that exacerbates the bleeding of patients with DAH, even when they show a good response to corticosteroids.

    Download PDF (2024K)
  • Mitsuo Hashimoto, Saki Kuriiwa, Ayako Kojima, Kyota Shinhuku, Akihito ...
    2017 Volume 56 Issue 4 Pages 429-433
    Published: February 15, 2017
    Released: February 15, 2017
    JOURNALS OPEN ACCESS

    A 76-year-old woman was diagnosed with lung tuberculosis. On the second day of anti-tuberculosis treatment, she became unconscious and developed status epilepticus accompanied by hyponatremia. The hyponatremia was caused by the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Detailed examinations revealed that the patient's status epilepticus had occurred due to hyponatremia, which was caused by lung tuberculosis-associated SIADH. Previous case reports noted that patients with tuberculosis-associated SIADH showed mild clinical manifestations. They also reported that extensive lung involvement was associated with SIADH development. We herein report a rare case of SIADH complicated with status epilepticus that was caused by tuberculosis with mild lung involvement.

    Download PDF (1390K)
  • Naoto Imoto, Nakashima Harunori, Katsuya Furukawa, Naoyuki Tange, Atsu ...
    2017 Volume 56 Issue 4 Pages 435-439
    Published: February 15, 2017
    Released: February 15, 2017
    JOURNALS OPEN ACCESS

    Pulmonary alveolar proteinosis (PAP) is classified as autoimmune, secondary, or genetic. We herein describe a 69-year-old man with autoimmune PAP, simultaneously diagnosed with myeloproliferative neoplasm (MPN). Two years after the diagnosis, the MPN progressed to acute myeloid leukemia, and the patient died from an alveolar hemorrhage during remission induction chemotherapy. Throughout the clinical course, no progression of PAP was observed, despite the progression to leukemia. There are few reports of autoimmune PAP with hematological malignancy, and this case demonstrated that an evaluation for GM-CSF autoantibodies is important for distinguishing the autoimmune and secondary forms of PAP, even if the patient has hematological malignancy.

    Download PDF (501K)
  • Yasuhiro Fuseya, Miyuki Kawamura, Eri Matsuda, Kozue Takada, Kiwamu Wa ...
    2017 Volume 56 Issue 4 Pages 441-444
    Published: February 15, 2017
    Released: February 15, 2017
    JOURNALS OPEN ACCESS

    We herein report a case of capsular warning syndrome (CWS) that was successfully treated with recombinant tissue plasminogen activator (rt-PA). A 70-year-old woman had repeated stereotyped transient ischemic attacks (TIAs) of right hemiparesis and dysarthria. After hospitalization, argatroban, aspirin, and cilostazol were started but were ineffective. Thirteen hours after the first episode of TIAs, severe symptoms occurred. Magnetic resonance imaging showed acute infarctions in the internal capsule to corona radiata, so we used rt-PA. Since then, the TIAs have not occurred, and the symptoms have considerably improved. This case suggests that rt-PA might be effective and safe for use in treating CWS.

    Download PDF (327K)
  • Eri Sugawara, Masaru Kato, Ryo Hisada, Kenji Oku, Toshiyuki Bohgaki, T ...
    2017 Volume 56 Issue 4 Pages 445-448
    Published: February 15, 2017
    Released: February 15, 2017
    JOURNALS OPEN ACCESS

    Pulmonary arterial hypertension (PAH) associated with systemic lupus erythematosus (SLE) or mixed connective tissue disease (MTCD), in contrast to other types of PAH, may respond to immunosuppressive therapy. Most PAH cases with an immunosuppressant response were in the early stages of the disease (WHO functional class III or less). The present case was a 34-year-old woman with MCTD-associated PAH (WHO functional class IV) who was resistant to a combination of three vasodilators. Afterwards, she was treated with glucocorticoid and cyclophosphamide. This case suggested the potential benefit of immunosuppressants in patients with severe MCTD-associated PAH.

    Download PDF (518K)
  • Yoshitsugu Higashi, Shigeki Nakamura, Nobuyuki Ashizawa, Kazuhiro Oshi ...
    2017 Volume 56 Issue 4 Pages 449-453
    Published: February 15, 2017
    Released: February 15, 2017
    JOURNALS OPEN ACCESS

    Pulmonary actinomycosis is a rare pulmonary infection that often exhibits unspecific symptoms and radiological findings. We herein report a case of pulmonary actinomycosis that mimicked pulmonary aspergilloma in an immunocompetent patient.

    Download PDF (1081K)
  • Shigeo Godo, Yoshitaro Yoshida, Motoo Fujita, Daisuke Kudo, Ryosuke No ...
    2017 Volume 56 Issue 4 Pages 455-459
    Published: February 15, 2017
    Released: February 15, 2017
    JOURNALS OPEN ACCESS

    Biguanides are a drug of choice for the treatment of type 2 diabetes mellitus. Although they can cause lactic acidosis in susceptible patients with predisposing risk factors, the incidence of lactic acidosis is reported to be very low when they are used properly. We herein present a case of biguanide-associated severe lactic acidosis complicated with thiamine deficiency that was provoked without predisposing factors for thiamine deficiency. Diabetic patients taking biguanide may be predisposed to thiamine deficiency, even when there is no evidence of risk factors, and the high-dose administration of thiamine may be essential in the treatment of this otherwise under-recognized disorder.

    Download PDF (162K)
PICTURES IN CLINICAL MEDICINES
feedback
Top