Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
最新号
選択された号の論文の29件中1~29を表示しています
REVIEW ARTICLES
  • Shu Kiyotoki, Jun Nishikawa, Isao Sakaida
    2020 年 59 巻 2 号 p. 153-161
    発行日: 2020/01/15
    公開日: 2020/01/15
    [早期公開] 公開日: 2019/06/27
    ジャーナル オープンアクセス

    Helicobacter pylori can infect the gastric mucosa and cause chronic inflammation, resulting in various diseases, including gastric cancer. Eradication of H. pylori in all infected subjects is recommended; however, the number of H. pylori strains with antibiotic resistance has increased, and the eradication rate has decreased. Vonoprazan, a potassium-competitive acid blocker, produces a stronger acid-inhibitory effect than proton pump inhibitors (PPIs). The H. pylori eradication rate with vonoprazan was found to be higher than that with PPIs. The H. pylori eradication rate with vonoprazan-based triple therapy (vonoprazan, amoxicillin, and clarithromycin) was approximately 90% and had an incidence of adverse events similar to that of PPIs. We review the current situation of H. pylori eradication in Japan, the first country in which vonoprazan was made available.

  • Eiki Ichihara, Nobuaki Miyahara, Yoshinobu Maeda, Katsuyuki Kiura
    2020 年 59 巻 2 号 p. 163-167
    発行日: 2020/01/15
    公開日: 2020/01/15
    [早期公開] 公開日: 2019/09/18
    ジャーナル オープンアクセス

    Systemic therapy for advanced non-small cell lung cancer (NSCLC) has dramatically changed in the latest 15 years. Molecular-targeted therapy has brought about an era of precision medicine, and immune checkpoint inhibitors have brought hope for a cure for advanced NSCLC. In the wake of this remarkable advancement, lung cancer with comorbid interstitial pneumonia (IP) has been completely left behind, as most clinical trials exclude patients with comorbid IP. IP, especially idiopathic pulmonary fibrosis (IPF), is often accompanied by lung cancer, and acute exacerbation can develop during various cancer therapies, including surgery, radiotherapy and pharmacotherapy. In this review, we focus on the clinical questions concerning pharmacotherapy in cases of advanced lung cancer with comorbid IP and discuss what we can do with the currently available data.

ORIGINAL ARTICLES
  • Hiroshi Isoda, Satoshi Oeda, Ayako Takamori, Keiko Sato, Michiaki Okad ...
    2020 年 59 巻 2 号 p. 169-174
    発行日: 2020/01/15
    公開日: 2020/01/15
    [早期公開] 公開日: 2019/09/18
    ジャーナル オープンアクセス

    Objective Despite recent advances in hepatitis C virus (HCV) treatment, some HCV-positive individuals are unaware of their infection. The present study aimed to assess the rate and age distribution in Saga Prefecture regarding i) HCV infection and HCV screening and ii) direct acting anti-viral (DAA) treatment.

    Methods HCV screening data collected at a medical institution or in the workplace were obtained from the administrative database in Saga Prefecture between April 1, 2008 and March 31, 2014. DAA treatment data from Saga Prefecture were obtained from the DAA treatment reimbursement recipient database between October 2014 and March 2017.

    Results There were 35,625 individuals who underwent HCV screening, and the HCV positive rate was 1.18% (421 individuals), which increased in an age-related manner. The screening rate in the screened populations peaked at 45-74 years of age (approximately 6%) and decreased in the younger and older generations. The estimated percentage of DAA treatment peaked at 65-74 years old (65.8%) and significantly decreased inversely with age in the younger generations; only 9.4% of HCV carriers received DAA treatment in the 20- to 34-year age group. The proportion of subjects who received a complete physical examination for DAA treatment was higher in the subjects who were screened at a medical institution than in those screened at the workplace.

    Conclusion The rate of subjects who underwent HCV screening and DAA treatment was not high, especially in the younger generation, in Saga Prefecture. This group should be targeted for HCV screening and treatment.

  • Tetsuhiko Yasuno, Toshiki Maeda, Kazuhiro Tada, Koji Takahashi, Kenji ...
    2020 年 59 巻 2 号 p. 175-180
    発行日: 2020/01/15
    公開日: 2020/01/15
    [早期公開] 公開日: 2019/09/26
    ジャーナル オープンアクセス

    Objective The revised Standards of Medical Care in Diabetes-2018 recommend a less-intensive HbA1c target for elderly individuals than for younger ones. This study aimed to investigate the development and progression of chronic kidney disease (CKD) according to HbA1c levels separately for elderly and middle-aged individuals in a general Japanese population.

    Methods This was a retrospective cohort study using health checkup data in Iki City, Japan. The participants of the study were 5,554 residents who attended health checkups more than 2 times over 8 years. This study consists of two sets of analyses to determine (1) the effects of HbA1c on the development of CKD among 4,570 subjects who did not have CKD at baseline and (2) the effects of HbA1c on the progression of CKD in 953 subjects with existing CKD at baseline.

    Results After adjusting for various risk factors, the multivariable-adjusted hazard ratios for development of CKD increased with the HbA1c level: 1.43 for 7-9% and 1.67 for >9% compared with the reference of <7% (p<0.306 for trend). Similar findings were also observed for the progression of CKD: hazard ratios of 2.48 for 7-9% and 2.46 for >9% compared with the reference of <7% (p<0.077 for trend). No significant differences in the effects of HbA1c level on the development or progression of CKD were observed between elderly and middle-aged individuals (p>0.3 for interaction).

    Conclusion The risks of the development and progression of CKD increased from HbA1c levels of 7% in a general Japanese population. Similar associations were observed for both elderly and middle-aged individuals.

  • Mutsuo Yamaya, Genichiro Kawakami, Haruki Momma, Aya Yamada, Jun Itoh, ...
    2020 年 59 巻 2 号 p. 181-192
    発行日: 2020/01/15
    公開日: 2020/01/15
    ジャーナル オープンアクセス

    Objective Pneumonia develops in bedridden patients, even in those receiving oral care, and malnutrition is associated with the development of pneumonia. We examined the effects of nutritional treatment on the prevention of pneumonia.

    Patients and Methods We retrospectively examined the effects of nutritional treatment on the prevention of pneumonia by analyzing the records of bedridden patients (n=68; mean age: 68.0 years) who stayed in a hospital for 2 years or longer.

    Results Among the analyzed patients, pneumonia developed in 52 (76%) patients, and the mean frequency of pneumonia was 1.6 times per year during the first year of stay. In a multivariate analysis, the serum albumin level at admission in the pneumonia group was lower than that in the non-pneumonia group. The frequency of pneumonia during the second year of stay was lower than that during the first year of stay. Serum levels of albumin and total protein (TP) at one year after admission were higher than those at admission in all analyzed patients, and in all patients (n=52) and elderly (≥65 years) patients (n=31) in the pneumonia group. The proportions of patients with hypoalbuminemia (<3.5 g/dL) and hypoproteinemia (<6.5 g/dL) at one year after admission were lower than those at admission. The increases in the proportions of patients presenting a reduced frequency of pneumonia were correlated with increases in the proportions of patients presenting increased levels of albumin and/or TP.

    Conclusion Nutritional treatment may reduce the frequency of pneumonia by improving malnutrition in bedridden patients receiving oral care.

  • Waki Imoto, Koichi Yamada, Kazushi Yamairi, Wataru Shibata, Hiroki Nam ...
    2020 年 59 巻 2 号 p. 193-198
    発行日: 2020/01/15
    公開日: 2020/01/15
    ジャーナル オープンアクセス

    Objective Hemorrhagic pneumonia due to Stenotrophomonas maltophilia (SM) in severely immunocompromised patients has a very poor prognosis. However, the risk factors for hemorrhagic pneumonia are not clear.

    Methods This study assessed the predictive factors of hemorrhagic pneumonia caused by SM. The medical records of patients admitted to Osaka City University Hospital with SM bacteremia between January 2008 and December 2017 were retrospectively reviewed.

    Patients All patients who had positive blood cultures for SM were included in this study. They were categorized into two groups: the SM bacteremia with hemorrhagic pneumonia group and the SM bacteremia without hemorrhagic pneumonia group. The clinical background characteristics and treatments were compared between these groups.

    Results The 35 patients with SM bacteremia included 4 with hemorrhagic pneumonia and 31 without hemorrhagic pneumonia. Hematologic malignancy (p=0.03) and thrombocytopenia (p=0.04) as well as the prior use of quinolone within 30 days (p=0.04) were more frequent in the SM bacteremia patients with hemorrhagic pneumonia than in those without hemorrhagic pneumonia. The mortality of the SM bacteremia patients with hemorrhagic pneumonia was higher than that of those without hemorrhagic pneumonia group (p=0.02).

    Conclusion Patients with SM bacteremia who have hematologic malignancy, thrombocytopenia, and a history of using quinolone within the past 30 days should be treated with deliberation.

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