Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
60 巻 , 5 号
  • Kyoichi Adachi, Norihisa Ishimura, Kanako Kishi, Takumi Notsu, Tomoko ...
    2021 年 60 巻 5 号 p. 667-674
    発行日: 2021/03/01
    公開日: 2021/03/01
    [早期公開] 公開日: 2020/09/30
    ジャーナル オープンアクセス

    Objective This study was conducted to clarify the prevalence of short segment Barrett's esophagus (SSBE) using endoscopic observations with linked color imaging (LCI). In addition, the relationship between the presence of Barrett's epithelium (BE) and the status of H. pylori infection was investigated.

    Methods The study subjects were 3,353 individuals (2,186 men, 1,167 women; mean age 55.2±9.4 years old) whose status of H. pylori infection had been determined. An endoscopic observation using LCI was performed to examine the distal margin of palisade vessels and confirm the area of BE. The prevalence of BE ≥5 mm in length was investigated.

    Results BE was diagnosed in 1,884 (56.2%) subjects, with lengths of <10, 10-19, 20-29, and ≥30 mm found in 1,005, 851, 27, and 1, respectively. Its prevalence in H. pylori-negative, H. pylori-positive, and post-eradicated subjects was 41.7%, 64.4%, and 69.9%, respectively (p<0.001). The duration since successful eradication of H. pylori did not affect the prevalence of BE. The degree of gastric mucosal atrophy was higher in cases with BE (p<0.001), although negativity for H. pylori infection and mild gastric mucosal atrophy were significant factors for the development of longer BE.

    Conclusion A high prevalence of SSBE was noted when LCI was used to determine the area of BE, as the distal end of the palisade vessels was easily visualized. Negativity for H. pylori infection and mild gastric mucosal atrophy were not correlated with SSBE prevalence.

  • Ryosaku Shirahashi, Toshikuni Suda, Masaya Tamano
    2021 年 60 巻 5 号 p. 675-680
    発行日: 2021/03/01
    公開日: 2021/03/01
    ジャーナル オープンアクセス

    Objective Hypozincemia is a decrease in the serum zinc level of patients with hepatitis C and often requires zinc supplementation to improve the hepatic function. Our previous study showed the efficacy of direct-acting antiviral agent (DAA) treatment on serum zinc levels in patients with hepatitis C without zinc supplementation. In this study, we aimed to prospectively examine factors related to the improvement of serum zinc levels of patents with hepatitis C with DAA treatment.

    Methods Fifty-three patients with hepatitis C treated with DAAs between March 2018 and February 2019 at a university medical center were divided into two groups based on their initial serum level: the zinc deficiency group (n=43, <80 μg/dL) and the normal zinc group (n=10, ≥80 μg/dL). Their serum zinc levels and clinical parameters were measured before DAA treatment, at the end of treatment and 12 weeks post-treatment.

    Results All 53 patients achieved a sustained viral response to DAAs at the end of treatment and at follow-up. There was a significant increase in the serum zinc level from baseline to follow-up in the zinc deficiency group but not in the normal zinc group. The change in serum albumin was the only factor contributing to the observed increase in serum zinc levels by a multiple regression analysis.

    Conclusion DAA treatment in patients with hepatitis C improved hypozincemia due to the restored function of serum albumin, which binds to about 60% of serum zinc, upon the amelioration of the hepatitis C infection.

  • Hitomi Nakayama, Yasushi Yamada, Kentaro Yamada, Shimpei Iwata, Nobuhi ...
    2021 年 60 巻 5 号 p. 681-688
    発行日: 2021/03/01
    公開日: 2021/03/01
    [早期公開] 公開日: 2020/10/21
    ジャーナル オープンアクセス

    Objective Although a number of studies have shown that both short and long sleep durations were associated with the risk of metabolic disorders related to obesity, the underlying mechanism is still not fully understood. In this study, we analyzed the association of sleep duration with metabolic, anthropometric, and lifestyle factors in patients with type 2 diabetes.

    Methods The subjects were 279 patients with type 2 diabetes 63 (52-70) years old (median and interquartile range) with a body mass index of 25.0 (22.2-28.3) kg/m2 and HbA1c levels of 8.7% (7.6-10.3%). Patients with advanced complications were excluded from the study. Diets were evaluated by registered dietitians using a software program. Body composition was assessed by the multifrequency bioelectrical impedance method.

    Results The mean self-reported nightly sleep duration was 6.4 hours with no marked gender difference. Sleep duration was inversely correlated with the HbA1c levels, total energy intake, and intakes of carbohydrate, protein, and fat. The body fat ratio and skeletal muscle mass were correlated positively and negatively, respectively, with sleep duration. When the subjects were divided into three groups based on sleep duration, the intakes of total energy, carbohydrates, and fat tended to be high in those with <5.5 hours of sleep, and the percentage of patients who had habitual physical activities was lower in those with >7 hours of sleep.

    Conclusion The observation that sleep duration is distinctly associated with excessive eating and a sedentary lifestyle may provide a basis for effective lifestyle management of patients with type 2 diabetes.

  • Yoichiro Otaki, Tetsu Watanabe, Tsuneo Konta, Masafumi Watanabe, Koich ...
    2021 年 60 巻 5 号 p. 689-697
    発行日: 2021/03/01
    公開日: 2021/03/01
    ジャーナル オープンアクセス

    Objective Despite advances in medicine, aortic diseases (ADs), such as aneurysm rupture and aortic dissection, remain fatal and carry extremely high mortality rates. Due to its low frequency, the risk of developing AD has not yet been fully elucidated. Chronic kidney disease (CKD) is an established risk factor for cardiovascular disease and mortality. The aim of the present study was to examine whether or not CKD is a risk for AD-related mortality in the general population.

    Methods We used a nationwide database of 554,442 subjects (40-75 years old) who participated in the annual "Specific Health Check and Guidance in Japan" checkup between 2008 and 2013.

    Results There were 131 aortic aneurysm and dissection deaths during the follow-up period of 2,123,512 person-years. A Kaplan-Meier analysis revealed that subjects with CKD had a higher rate of AD-related deaths than those without it. A multivariate Cox proportional hazard regression analysis demonstrated that CKD was an independent risk factor for AD-related death in the general population after adjusting for cardiovascular risk factors. The addition of CKD to cardiovascular risk factors significantly improved the C, net reclassification, and integrated discrimination indexes.

    Conclusion CKD is an additional risk for AD-related death, suggesting that CKD may be a target for the prevention and early identification of subjects at high risk for AD-related death in the general population.

  • Toshihiro Miyamoto, Masaki Iino, Yasuji Komorizono, Toru Kiguchi, Nobu ...
    2021 年 60 巻 5 号 p. 699-707
    発行日: 2021/03/01
    公開日: 2021/03/01
    ジャーナル オープンアクセス

    Objective For patients with Gaucher disease (GD), a rare, inherited lysosomal storage disease, obtaining a definitive diagnosis is currently time-consuming and costly. A simplified screening method to measure the glucocerebrosidase (GBA) activity using dried blood spots (DBS) on filter paper has recently been developed. Using this newly developed screening method, we evaluated real-world GD screening in patients suspected of having GD.

    Methods This multicenter, cross-sectional, observational study with a diagnostic intervention component evaluated real-world screening in patients suspected of having GD based on their clinical symptoms and a platelet count <120,000/μL. The endpoint was the number of patients with low GBA activity determined using DBS.

    Results In 994 patients who underwent initial DBS screening, 77 had low GBA activity. The assay was not repeated in 1 patient who was diagnosed as having a high possibility of GD due to clinical symptoms, and a further 21 patients completed the study without undergoing the second assay. Of the remaining 55 patients who had 2 DBS assays performed, 11 had a low GBA activity in both assays. Overall, DBS screening identified 12 (1.2%) patients with a low GBA activity, a proportion consistent with prior screening studies.

    Conclusion These results suggest that the simplified DBS method was less burdensome to patients, was easily utilized by many physicians, and could be a useful first-tier screening assay for GD prior to initiating burdensome genetic testing.

  • Junya Makiyama, Yoshitaka Imaizumi, Haruka Watanabe, Machiko Fujioka, ...
    2021 年 60 巻 5 号 p. 709-718
    発行日: 2021/03/01
    公開日: 2021/03/01
    [早期公開] 公開日: 2020/10/21
    ジャーナル オープンアクセス

    Objective Classic Hodgkin lymphoma (CHL) has been regarded as a curable disease when treated appropriately, especially in younger patients, and ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) has been regarded as the standard regimen. However, a relatively poor prognosis has been reported in older patients with CHL, and the efficacy and tolerability of the ABVD regimen has not been fully elucidated. We retrospectively investigated the outcomes in patients with CHL treated with ABVD at our institute.

    Methods Twenty-five patients were evaluated; 14 were ≤60 years of age, and 11 were >60 years of age (older group).

    Results The ABVD doses were reduced in all patients in the older group; the median average relative dose intensity was 0.58. In the older group, the 5-year overall survival (OS) and median OS were 100% and not reached, respectively, for patients with early-stage CHL and 66.7% and not reached, respectively, for those with advanced-stage CHL. No patients died of CHL, and only one treatment-related death was observed in the older group.

    Conclusion ABVD with dose attenuation may represent a feasible and effective strategy for the treatment of older patients with CHL in clinical practice, particularly in those with early-stage disease, although the optimal degree of attenuation remains unclear.