Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
57 巻 , 18 号
選択された号の論文の29件中1~29を表示しています
EDITORIAL
REVIEW ARTICLE
  • Masayuki Amano, Taro Shimizu
    2018 年 57 巻 18 号 p. 2607-2612
    発行日: 2018/09/15
    公開日: 2018/09/15
    [早期公開] 公開日: 2018/05/18
    ジャーナル オープンアクセス

    Mondor's disease (MD) is a rare disease that manifests with a palpable cord-like induration on the body surface. In general, MD is a self-limited, benign thrombophlebitis that resolves in four to eight weeks without any specific treatment. Cases of MD can be roughly categorized into three different groups based on the site of the lesion as follows: original MD of the anterolateral thoracoabdominal wall, penile MD with dorsum and dorsolateral aspects of the penis, and axillary web syndrome with mid-upper arm after axillary surgery. The diagnosis of MD is rather straightforward and based on a physical examinations. However, some case occur "secondary" with another underlying disease, including malignancy, a hypercoagulative state, and vasculitis. Therefore, it is critical to identify MD precisely, evaluate any possible underlying disease, and avoid any unnecessary invasive tests or treatment. In this paper, we comprehensively review the clinical characteristics of MD.

ORIGINAL ARTICLES
  • Kenichiro Majima, Yosuke Muraki, Takeshi Shimamoto
    2018 年 57 巻 18 号 p. 2613-2619
    発行日: 2018/09/15
    公開日: 2018/09/15
    [早期公開] 公開日: 2018/04/27
    ジャーナル オープンアクセス

    Objective Multiple white and flat elevated lesions (MWFLs) observed in the stomach have only been presented in abstracts at academic conferences over the last decade; therefore, relatively little is known about these lesions. Our aim was to prospectively clarify the clinical characteristics of MWFLs, to identify their risk factors and to retrospectively evaluate the clinical progression of these lesions.

    Methods A prospective analysis of clinical characteristics and risk factors was conducted in participants who underwent esophagogastroduodenoscopic screening at our hospital. A retrospective analysis of the medical chart of patients identified as having MWFLs was conducted to describe the clinical progression of these lesions.

    Results The prevalence rate of MWFLs was 10.4% (80/767), with the following risk factors identified on a logistic regression analysis: use of proton pump inhibitors [odds ratio (OR), 3.51; 95% confidence interval (CI), 1.92-6.43], female sex (OR, 1.92; 95% CI, 1.19-3.12) and a 1-year increase in age (OR, 1.05; 95% CI, 1.02-1.08). Among the 70 cases with MWFLs observed over a mean duration of 2.3 years, no progression of MWFLs was detected in 67 cases (96%). Among the 3 remaining cases, progression was mild, with none of the lesions progressing to malignancy.

    Conclusion The use of proton pump inhibitors (PPIs), female sex, and age are risk factors for MWFLs. We believe that endoscopists should recognize these lesions.

  • Satoru Suzuki, Seigo Sugiyama
    2018 年 57 巻 18 号 p. 2621-2630
    発行日: 2018/09/15
    公開日: 2018/09/15
    [早期公開] 公開日: 2018/04/27
    ジャーナル オープンアクセス

    Objective B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) should be secreted from cardiomyocytes in response to increased myocardial wall stress in a molar ratio of 1.00; however, the calculated molar blood levels of NT-proBNP are often greater than those of BNP in routine clinical practice. The purpose of this study was to investigate the hypothesis that the molar ratio of NT-proBNP/BNP provides useful clinical information in stable outpatients with cardiovascular risk factors.

    Methods We measured both the BNP and NT-proBNP levels simultaneously in 551 consecutive, stable outpatients with at least one cardiovascular risk factor and then calculated the molar ratio of NT-proBNP/BNP. All patients were prospectively followed-up for the occurrence of heart failure (HF)-related events.

    Results Of those patients, 38 patients had an HF-related event. A multivariate Cox hazards analysis showed that the log (molar ratio of NT-proBNP/BNP) was an independent predictor of future HF-related events (p=0.039). A Kaplan-Meier analysis showed a significantly higher probability of HF-related events in patients with a higher molar ratio of NT-proBNP/BNP (≥1.70) (p<0.001). The area under the curve (AUC) of the receiver operating characteristic curve (ROC) for the molar ratio of NT-proBNP/BNP to predict HF-related events was 0.75 (p<0.001). The AUC of the ROC curve analysis with the molar ratio of NT-proBNP/BNP for the prediction of HF-related events was not significantly greater than that of BNP or NT-proBNP.

    Conclusion The molar ratio of NT-proBNP/BNP may be a significant prognostic factor for HF-related events.

  • Katsuhiko Ogawa, Yutaka Suzuki, Takayoshi Akimoto, Keiji Shiobara, Mak ...
    2018 年 57 巻 18 号 p. 2631-2639
    発行日: 2018/09/15
    公開日: 2018/09/15
    [早期公開] 公開日: 2018/04/27
    ジャーナル オープンアクセス

    Objective An abnormal high intensity area (HIA) on diffusion-weighted imaging (DWI) indicates the presence of cytotoxic edema and has been reported to be observed in the hippocampus of patients with transient global amnesia (TGA). The appearance of an HIA on DWI is usually delayed after the onset of patients with amnesia in TGA; thus, the significance of the HIA was evaluated in patients with TGA.

    Methods Three adult TGA patients who had a unilateral HIA on DWI (right, n=2; left, n=1) were enrolled. These patients were hospitalized due to acute-onset amnesia. Amnesia subsided within 24 hours of hospitalization in all three patients.

    Results The HIA was confined to the upper lateral zone of the body in the unilateral hippocampus where the CA1 region exists. The lesions were confirmed after the improvement of amnesia in the three patients. The location of the lesions corresponded to the watershed area where the upper and lower hippocampal arteries were anastomosed.

    Conclusion Cytotoxicity caused by glutamate-mediated calcium influx in the neurons of the CA1 region was recently reported in the pathogenesis of TGA. Based on the pathogenesis, the cytotoxicity was considered to have been caused by calcium overload throughout the entire CA1 region, and amnesia occurred due to this cytotoxicity. The cytotoxicity was more marked in the lesions because of the lower blood flow in the watershed area and was prolonged after the function of the CA1 region (excluding the watershed area) improved, which led to cytotoxic edema in the lesions.

  • Tetsuro Konishi
    2018 年 57 巻 18 号 p. 2641-2645
    発行日: 2018/09/15
    公開日: 2018/09/15
    [早期公開] 公開日: 2018/05/18
    ジャーナル オープンアクセス

    Objective The aim of this study was to clarify the clinical conditions related to the depressive mental states in Japanese patients with subacute myelo-optico-neuropathy (SMON), caused by clioquinol intoxication more than 40 years previously.

    Methods The changes in the mental states with aging were investigated in 25 Japanese SMON patients (mean age: 77.2 years old, range: 53-90) using a Japanese version of the Zung Self-rating Depression Scale (J-SDS) questionnaires with supportive interviews by the clinical psychotherapist and medical checkup records. These mental and medical examinations were repeated more than twice within 2 to 11 years' interval. The J-SDS questionnaires were also examined in 25 age-matched non-SMON elderly people.

    Results The total J-SDS scores of most of the SMON patients decreased with age without significant changes in the mean Barthel index scores during this study period. The mean J-SDS scores at the first and latest studies were significantly higher than in the age-matched healthy elderly people. The total J-SDS scores of the latest study were significantly correlated with the degree of physical disability, such as the inverse total Barthel index scores, severity of SMON or gait disturbance, but not with the age.

    Conclusion The total J-SDS scores of most of the SMON patients tended to decrease with age. Repeating mental supportive interviews and medical examinations by experts helped to improve the depressive mental state and revealed close relationship between the mental state and the physical disabilities of the SMON patients.

  • Kazunori Sato, Masaaki Niino, Atsushi Kawashima, Moemi Yamada, Yusei M ...
    2018 年 57 巻 18 号 p. 2647-2655
    発行日: 2018/09/15
    公開日: 2018/09/15
    [早期公開] 公開日: 2018/04/27
    ジャーナル オープンアクセス

    Objective In Japan, following the launch of dimethyl fumarate (DMF) after fingolimod as a disease-modifying drug in multiple sclerosis (MS), some patients switched from fingolimod to DMF. The aim of this study was to determine the follow-up status of MS patients who switched to DMF after fingolimod cessation.

    Methods Clinical and magnetic resonance imaging (MRI) data in 19 patients with MS who switched to DMF were collected for at least for 6 months after fingolimod cessation.

    Results Ten patients (52.6%) experienced clinical or MRI exacerbation after fingolimod cessation. The peripheral blood lymphocyte counts at the time of fingolimod cessation in those with disease exacerbation were significantly lower than in those without exacerbation. The patients with disease exacerbation were further classified into three groups based on MRI findings: those with some new T2-weighted lesions with or without gadolinium (Gd) enhancement (group I), those with more new and/or enlarged T2-weighted lesions with Gd enhancement compared to pre-fingolimod induction (group II), and those with multifocal tumefactive demyelinating lesions. In group II, the clinical disease activity, which was similar to that at fingolimod initiation in group I, was higher than the clinical disease activity observed before fingolimod initiation. Conversely, group III exhibited unexpected new MRI findings that were not evident before fingolimod initiation.

    Conclusion Cessation of fingolimod might precipitate rebound or reactivation of clinical disease in patients with MS, and careful follow-up is necessary for patients who discontinue fingolimod.

CASE REPORTS
PICTURES IN CLINICAL MEDICINES
feedback
Top