Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
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Displaying 1-50 of 408 articles from this issue
  • Kenji Inoue, Masatsugu Hasegawa, Ryosuke Sato, Michio Kobayashi
    Article ID: 2828-23
    Published: 2024
    Advance online publication: April 09, 2024
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    The salivary glands of marine carnivorous gastropods contain tetramines, which usually cause mild symptoms of poisoning. However, these symptoms may be fatal in rare cases. A 58-year-old woman with a history of myasthenia gravis complained of dyspnea after consuming marine carnivorous gastropods with intact salivary glands. Upon arrival at the hospital, her blood gas analysis revealed type II respiratory failure with a pCO2 of 154 mmHg. Tracheal intubation was immediately performed. Her respiratory condition improved the following day, and she therefore could be weaned off the ventilator. Tetramine poisoning can be fatal for patients with certain underlying medical conditions.

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  • Yu Kodama, Takero Terayama, Takuma Oguro, Tetsuro Kiyozumi
    Article ID: 2902-23
    Published: 2024
    Advance online publication: April 09, 2024
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  • Kenji Ishiguro, Kazuhiro Ishikawa, Takahiro Matsuo, Nobuyoshi Mori
    Article ID: 2922-23
    Published: 2024
    Advance online publication: April 09, 2024
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    Sialadenitis has rarely been reported in patients with infectious mononucleosis (IM). Our patient was a 22-year-old man who presented with bilateral swelling of the parotid and submandibular glands, a fever, malaise, and splenomegaly. Laboratory tests revealed an increased percentage of atypical lymphocytes in the leukocyte fraction. Serological testing for antibodies against Epstein-Barr virus (EBV) revealed an acute infection pattern. The patient was diagnosed with sialadenitis associated with IM caused by EBV infection. With symptomatic treatment, the salivary gland swelling completely resolved within a week. This case suggests that EBV-induced IM should be included in the differential diagnosis of diffuse sialadenitis with elevated atypical lymphocyte counts.

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  • Masashi Yokoi, Tsuyoshi Ito, Yu Kawada, Junki Yamamoto, Toshiyuki Yama ...
    Article ID: 2945-23
    Published: 2024
    Advance online publication: April 09, 2024
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    The prognosis of myocardial infarction with non-obstructive coronary arteries (MINOCA) is reported to be as worse as myocardial infarction with obstructive coronary arteries. However, its mechanical complications are still poorly understood. A 71-year-old woman developed MINOCA after ascending aortic replacement surgery. During treatment, the patient experienced cardiogenic shock due to a ventricular septal rupture (VSR). The introduction of Impella devices reduced the left-to-right shunt and improved the patient's hemodynamics. Finally, a scheduled surgical repair was performed under stable conditions. In this report, we focused on the pathophysiology of MINOCA-related VSR and discussed the effectiveness of Impella devices as a bridge to surgical repair and circulatory backup during the perioperative period.

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  • Katsuyoshi Katayama, Haruhito A. Uchida, Aya Takehara, Jun Wada
    Article ID: 3050-23
    Published: 2024
    Advance online publication: April 09, 2024
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  • Akira Ikeya, Miho Yamashita, Keisuke Kakizawa, Yuto Kawauchi, Akio Mat ...
    Article ID: 3084-23
    Published: 2024
    Advance online publication: April 09, 2024
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    17α-hydroxylase deficiency is a type of congenital adrenocortical hyperplasia that is typically diagnosed in childhood or adolescence. It manifests as hypertension with gonadal dysfunction as the primary symptom. We herein report 17α-hydroxylase/17,20-lyase deficiency (17OHD) diagnosed at the age of 45 years. The patient presented with hypertension, irregular menstruation, and hyperaldosteronism. The clinical manifestations of 17OHD vary based on the specific variant pattern of CYP17A1. In this case, the variant was c.157_159 TCC del p. Phe53del, which has been frequently reported in Japan. The enzymatic deficiency due to this variant is partial, leading to a delay in making a correct diagnosis.

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  • Shuichi Fujita, Fumio Terasaki, Itsuro Morishima, Masaaki Hoshiga
    Article ID: 3253-23
    Published: 2024
    Advance online publication: April 09, 2024
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    We herein report a patient with type I CD36 deficiency. The patient was initially suspected of having isolated cardiac sarcoidosis based on the presence of non-sustained ventricular tachycardia, delayed myocardial enhancement on magnetic resonance imaging (MRI), and diffuse accumulation of 18F-fluorodeoxyglucose (18F-FDG) on cardiac positron emission tomography (PET). Our findings suggest that the diagnosis of cardiomyopathy associated with CD36 deficiency is often missed, highlighting the importance of a differential diagnosis of isolated cardiac sarcoidosis.

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  • Noboru Hamada, Shinsuke Hashida, Sachi Okawa, Toshimitsu Suwaki
    Article ID: 3254-23
    Published: 2024
    Advance online publication: April 09, 2024
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  • Toshio Suzuki, Ikuo Sekine
    Article ID: 3271-23
    Published: 2024
    Advance online publication: April 09, 2024
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  • Kosuke Takayama, Shin Fujisawa, Takayuki Sakuma, Kodai Hasegawa, Kengo ...
    Article ID: 3322-23
    Published: 2024
    Advance online publication: April 09, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Assisted reproductive technology is a viable option for pregnant women with chronic myeloid leukemia. We herein report the case of a patient who underwent successful fertility treatment with frozen embryo preservation at 36 years of age, followed by embryo transfer at 39 years of age, thus resulting in pregnancy and delivery after a third discontinuation of tyrosine kinase inhibitors (TKI). Despite the difficulty of long-term TKI withdrawal, the patient's strong desire for a baby led to a successful pregnancy and delivery with no apparent deformities or abnormalities. Thus, our case highlights the importance of collaboration between reproductive medicine physicians and hematologists.

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  • Genki Fujii, Ryosuke Yoshihara, Toshiki Hyodo, Ikuhiro Ishida, Ryoko O ...
    Article ID: 3397-23
    Published: 2024
    Advance online publication: April 09, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a complication caused by antithyroid drugs, particularly propylthiouracil (PTU). Most patients experience organ failure due to the affects of the treatment regimen. We herein report the case of an 89-year-old woman whose severe AAV induced by PTU resulted in various instances of organ failure that eventually led to death after 9 years of PTU therapy. During autopsy, we identified five types of organ failure. As AAV is a potentially fatal disease, the development of various vasculitis symptoms during PTU therapy should therefore be carefully monitored.

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  • Ryo Katsumata, Tomoka Kaburagi, Takayuki Hosokawa, Noriaki Manabe, Man ...
    Article ID: 3433-24
    Published: 2024
    Advance online publication: April 09, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Objective Gastrointestinal (GI) disorders such as functional dyspepsia (FD), irritable bowel syndrome (IBS), gastroesophageal reflux disease (GERD), and inflammatory bowel disease (IBD) can exhibit overlapping GI symptoms, including abdominal pain and alterations in bowel habits. The symptoms of GI disorders are commonly considered to be triggered and exacerbated by fatty food intake. Therefore, this study aimed to compare the food preferences of patients with GI disorders.

    Methods Forty food images (including fatty and light foods) and 20 animal images were selected to evaluate food preferences. The preference score was assessed using a visual analog scale ranging from 1 to 100. GI symptoms were evaluated using the GI Symptom Rating Scale (GSRS), and correlations between the GSRS and preference scores were investigated.

    Results Overall, 22 healthy controls and 23, 29, 27, and 20 patients with FD, IBS, GERD, and IBD, respectively, were enrolled. The preference score for all foods in patients with FD was significantly lower than that in healthy controls and those with IBS, GERD, and IBD (52.9 vs. 66.5 vs. 68.5 vs. 69.1 vs. 70.7, p<0.01). The score of fatty foods was lower in patients with FD than in healthy controls and those with IBS, GERD, and IBD (43.8 vs. 72.3 vs. 77.5 vs. 77.4 vs. 80.7, p<0.01), whereas that of light foods and animal images was not different among the groups. No significant correlation was found between the preference score and symptom severity.

    Conclusions Patients with FD had a negative preference for foods, particularly fatty foods, independent of the severity of GI symptoms.

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  • Yuki Tamura, Atsushi Naganuma, Yuhei Suzuki, Sanae Uehara, Takashi Hos ...
    Article ID: 3439-23
    Published: 2024
    Advance online publication: April 09, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Atopic dermatitis is common in children and often treated with topical corticosteroids (TCs). A boy in his late teens who had been using TCs for atopic dermatitis was diagnosed with liver damage during a health checkup. A medical examination revealed severe steatotic liver disease and elevated liver enzyme levels despite the absence of typical symptoms such as central obesity. After discontinuation of TCs, an improvement in liver enzyme levels was observed, leading to the diagnosis of drug-induced steatohepatitis. This case underscores the potential liver risks associated with prolonged TC use in children, highlighting the need for parental education.

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  • Shinya Yamanaka, Mariko Nishihara, Madoka Kondo, Kotaro Miyata, Zhehao ...
    Article ID: 3442-23
    Published: 2024
    Advance online publication: April 09, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    A 34-year-old transgender woman presented with ventricular tachycardia and was diagnosed with takotsubo cardiomyopathy. Further evaluation revealed an underlying diagnosis of multiple sclerosis (MS) with brainstem lesions that may have triggered takotsubo cardiomyopathy. In this report, we also systematically reviewed published cases of takotsubo cardiomyopathy and MS and found that basal type takotsubo cardiomyopathy was the most common, and most patients presented with brainstem involvement of MS. An awareness of these associations by physicians, along with multidisciplinary collaboration, may facilitate the early diagnosis and improve the prognosis of these patients.

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  • Kiyohide Takahashi, Shuhei Miyagi, Miho Nishiyama, Tsutomu Shinohara
    Article ID: 3466-24
    Published: 2024
    Advance online publication: April 09, 2024
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  • Yoshikuni Shoji, Yuki Saito, Yasuo Okumura
    Article ID: 3551-24
    Published: 2024
    Advance online publication: April 09, 2024
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  • Yusuke Watanabe, Itaru Nakamura, Yuri Ishii, Jun Oda
    Article ID: 3576-24
    Published: 2024
    Advance online publication: April 09, 2024
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  • Keigo Kobayashi, Yasuhiro Umekawa
    Article ID: 3582-24
    Published: 2024
    Advance online publication: April 09, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    In Japan, public health improvements have lessened parasitic infections, but increased global travel has introduced new disease risks. We report the case a Japanese man who had previously resided in Vietnam, who experienced appendicitis and the presence of segments in his stool. Gastrografin led to the expulsion of Taenia saginata, as confirmed by scolex identification. Remarkably, the appendicitis symptoms subsided after deworming. This case underscores the importance of considering cestode infections in the differential diagnosis of appendicitis, particularly for patients with relevant travel histories, and highlights the evolving challenges in global health and the significance of acquiring detailed patient histories.

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  • Satoshi Nakamura, Tomotsugu Takano, Kousei Nakatsuru, Kazuya Tsubouchi ...
    Article ID: 3601-24
    Published: 2024
    Advance online publication: April 09, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Nodal T-follicular helper cell lymphoma (nTFHL), a hematologic neoplasm originating from T-follicular helper (TFH) cells, occasionally presents with pulmonary radiographic abnormalities, without neoplastic cellular infiltration. However, the precise mechanisms underlying non-neoplastic pulmonary opacities in patients with nTFHL remain unclear. Previous reports have shown that TFH cell abnormalities are associated with collagen disease and interstitial pneumonia with autoimmune features (IPAF). We herein report a patient with nTFHL accompanied by interstitial pneumonia diagnosed via lung and lymph node biopsies. These findings suggest the need to rule out nTFHL before diagnosing IPAF.

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  • Ken-ichiro Inoue
    Article ID: 3627-24
    Published: 2024
    Advance online publication: April 09, 2024
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  • Kenshiro Arao
    Article ID: 3683-24
    Published: 2024
    Advance online publication: April 09, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
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  • Takeshi Takakubo, Yuko Odagiri, Masaki Machida, Tomoko Takamiya, Norit ...
    Article ID: 2697-23
    Published: 2024
    Advance online publication: April 02, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Background: This longitudinal study aimed to clarify the changes in the medical treatment behavior of Japanese patients with chronic diseases during the early phase of the COVID-19 pandemic and examine the factors associated with disease worsening.

    Methods: Subjects with chronic diseases were selected from a panel survey that started at the beginning of the COVID-19 pandemic consists of 2,400 participants recruited via the Internet. Medical treatment behaviors (decrease in medical visit frequency, inability to take regular medications, and utilization of telephone/online medical care), psychological distress, and sociodemographic factors were evaluated at baseline (May 2020) and at the follow-up survey (February 2021). A worsening of chronic diseases was defined as those who answered yes to the question, "Has-the-condition-of-the-chronic-disease-worsened?". The factors related to the worsening of chronic diseases at follow-up were examined.

    Results: A total of 514 participants (mean age 61.6±12.9 years) were analyzed. The percentage of participants who reported decreasing medical visit frequency was 34% at the baseline and 16.5% at follow-up, and those who reported a worsening of chronic diseases was 5.1% and 5.1%, respectively. A worsening of chronic diseases at follow-up was significantly associated with a younger age, a decreased frequency of medical visits, unemployment, a history of smoking, and psychological distress.

    Conclusions: A decreased frequency of medical visits was observed among one-third of the participants with chronic disease in the early stage of the pandemic, and it reduced by half at follow-up. In the early stages of an emerging infectious disease pandemic, decreased regular hospital/clinic visits can lead to a worsening of chronic diseases. Those who had psychological distress, unemployment, and a history of smoking were vulnerable to a worsening chronic disease.

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  • Fumisato Kozakai, Takahisa Ogawa, Toshitaka Sakai, Shinsuke Koshita, Y ...
    Article ID: 2760-23
    Published: 2024
    Advance online publication: April 02, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Aims: Surgery is recommended for large pedunculated gallbladder polyps (PGPs), which measure 10 mm or more in size, because they tend to be neoplastic polyps (NPs), such as adenomas and adenocarcinomas. However, after resection, they are often found to be non-neoplastic polyps (non-NPs). This study aimed to evaluate the usefulness of plain CT in distinguishing NPs from non-NPs. Methods: Of the 80 patients who underwent cholecystectomy for PGPs ( 10 mm between January 2008 and February 2021, 46 who underwent plain and contrast-enhanced CT (CE-CT) before resection were included in this study. We retrospectively assessed the polyp detection rate (PDR) using CT and calculated the difference in the CT values between PGPs and the surrounding bile. Results: Twenty-one patients had NPs (12 adenomas, 5 carcinomas in adenoma, and 4 adenocarcinomas). The others were non-NPs (24 cholesterol polyps and one hyperplastic polyp). The PDR using plain CT was significantly higher in the NP group than in the non-NP group (38% (8/21) vs. 0% (0/25), p <0.01). The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of NPs were 38%, 100%, 100%, 66%, and 72%, respectively. The difference in the CT values between PGPs and the surrounding bile was significantly larger in the NP group than in the non-NP group (14.12 ± 11.38 HU, 5.04 ± 6.15 HU, p <0.01). Conclusions: PGPs detected using plain CT had a high probability of being NPs. Plain CT is therefore considered to be useful for differentiating NPs from non-NPs.

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  • Hiroyuki Sumikura, Mai Ito, Takuma Sato, Naoki Hatayama, Tomohiro Fuji ...
    Article ID: 2767-23
    Published: 2024
    Advance online publication: April 02, 2024
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    A 44-year-old woman with a subacute onset of an altered mental status, urinary retention, and fluctuating blood pressure was initially diagnosed with anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis, meeting the criteria of Graus et al. Cardiac arrest occurred, which required pacemaker placement. She subsequently showed profound flaccid limb paralysis, with magnetic resonance imaging demonstrating focal necrotic lesions localized in the anterior horn of the longitudinal segments of the spinal cord and in the pontine tegmentum. Enteroviruses or autoimmune encephalitis-associated autoantibodies were not detected. We herein report a case of acute flaccid myelitis with profound psychiatric symptoms and dysautonomia, resembling NMDAR encephalitis.

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  • Keisuke Mizutani, Keita Sakurai, Yuto Uchida, Ken Hashimoto, Tomohiro ...
    Article ID: 2888-23
    Published: 2024
    Advance online publication: April 02, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    A 65-year-old woman presented with fever and abnormal behavior. Magnetic resonance imaging showed swelling of the left medial temporal lobe and an intracranial extra-axial occipital tumor. While her neurological symptoms improved after the administration of corticosteroid therapy under the suspicion of autoimmune encephalitis, the occipital tumor unexpectedly shrank, and the diagnosis of a solitary plasmacytoma was confirmed by biopsy. Additional examinations revealed elevated anti-glutamate receptor antibodies in the cerebrospinal fluid. The patient was diagnosed with autoimmune encephalitis concurrent with an intracranial solitary plasmacytoma. Central nervous system involvement can be considered a neurological complication in patients with a solitary plasmacytoma.

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  • Jun Nakamura, Ken Haruma, Noriaki Manabe, Tomoki Yamatsuji, Yoshinori ...
    Article ID: 2950-23
    Published: 2024
    Advance online publication: April 02, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Objective Esophageal cancer is a gastrointestinal cancer with a poor prognosis. However, it is curable and can be treated endoscopically if it is detected at an early stage. The objective of this study was to identify the factors that contribute to early detection.

    Methods From April 2011 to December 2019, we retrospectively investigated consecutive patients diagnosed with esophageal squamous cell carcinoma (ESCC) through upper gastrointestinal endoscopy at two hospitals of Kawasaki Medical University based on medical records. The factors contributing to the early detection of ESCC were investigated by comparing patients with ESCC with those undergoing health checkups in whom no organic lesions were found in the upper gastrointestinal tract on endoscopy (controls).

    Patients Factors contributing to early detection were examined in 402 ESCC cases and 391 sex- and age-matched controls, and early and advanced cancers were compared along with the risk factors for ESCC.

    Results A multivariate analysis showed that alcohol consumption and smoking, concomitant cancer of other organs, and a low body mass index (BMI) were factors associated with ESCC (odds ratio [OR], 4.65; 95% confidence interval [CI], 2.880-7.520, OR,3.63; 95% CI, 2.380-5.540, OR, 2.09; 95% CI, 1.330-3.270, OR, 6.38; 95% CI, 3.780-10.800), whereas dyslipidemia was significantly less common in patients with ESCC (OR, 0.545; 95% CI, 0.348-0.853). Comparing early and advanced cancers, a history of endoscopic screening was the only factor involved in early detection (OR, 7.93; 95% CI, 4.480-14.00).

    Conclusion The factors associated with ESCC include alcohol consumption, smoking, concomitant cancer of other organs, and a low BMI. Endoscopy in subjects with these factors may therefore be recommended for the early detection of ESCC.

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  • Kyosuke Matsunaga, Muneaki Kikuno, Hiroki Sakamoto, Hirofumi Okada, Ta ...
    Article ID: 2996-23
    Published: 2024
    Advance online publication: April 02, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    A 31-year-old man with neurofibromatosis type 1 (NF-1) had undergone resection of a malignant peripheral nerve sheath tumor (MPNST) on the buttock 3 months previously. He subsequently underwent mechanical thrombectomy for a hyperacute left middle cerebral artery embolism. Histopathologically, the emboli comprised neurofilament-positive pleomorphic tumor cells with geographic necrosis and conspicuous mitosis and were identified as MPNST. The patient died of respiratory failure due to lung MPNST metastasis on day 15 of hospitalization. To our knowledge, this is the first report of a spontaneous cerebral embolism due to MPNST in a NF-1 patient.

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  • Hiroto Inoue, Osamu Inatomi, Hiroshi Matsumoto, Hidenori Kimura, Takah ...
    Article ID: 3300-23
    Published: 2024
    Advance online publication: April 02, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Cytokeratin (CK) is a specific marker of adenocarcinoma. However, cases of CK7-positive esophageal squamous cell carcinoma (ESCC) have only rarely been reported. We herein report a case of unresectable CK7-positive ESCC with aggressive liver metastasis following nivolumab treatment initiation. Nivolumab treatment was discontinued after one course because of complications. Notably, the liver metastases exhibited accelerated growth. Immunostaining of the necropsy specimens revealed diffuse positivity for forkhead box protein A1 (FOXA1)/CK7, thus indicating a potent poor immune response. The potential correlation between CK7 expression and the immune checkpoint inhibitor response may offer valuable insights into the development of effective therapeutic strategies.

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  • Tomohisa Tsuyuki, Kenta Torigoe, Masatoshi Shimizu, Hiroshi Taira, Ryo ...
    Article ID: 3347-23
    Published: 2024
    Advance online publication: April 02, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    A 78-year-old male was admitted to the hospital with acute renal failure and generalized erythema after starting dapagliflozin 10 mg/day for chronic kidney disease (CKD). A skin biopsy revealed superficial perivascular dermatitis with eosinophils. A renal biopsy revealed lymphocytic and eosinophilic infiltration of the interstitium, and focal tubulitis. The patient was diagnosed with a dapagliflozin-induced drug reaction with eosinophilia and systemic symptoms (DRESS), followed by acute interstitial nephritis (AIN), and prednisolone therapy was therefore initiated. The patient's renal function improved, and erythema disappeared. To our knowledge, this is the first report of DRESS caused by dapagliflozin, and the patient was successfully treated with prednisolone.

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  • Kyoichi Adachi, Eiko Okimoto, Yuri Ebisutani, Kanako Kishi, Norihisa I ...
    Article ID: 3396-23
    Published: 2024
    Advance online publication: April 02, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Objective The presence of a short white hair-like appearance in the lower esophagus has recently been noted during esophagogastroduodenoscopy (EGD) at our institution. Histological findings showed that this formation was a spiked protrusion of the esophageal papilla. The results regarding the prevalence of such lesions in individuals who underwent EGD examinations as part of medical checkup procedures are herein presented.

    Methods The EGD results of 14,338 individuals (9,225 males, 5,113 females; mean age 54.0±9.8 years) were examined. The findings related to the presence of multiple lesions with a short white hair-like appearance in the lower esophagus of patients with reflux esophagitis, esophageal squamous papilloma, or gastric mucosal atrophy (GMA), as well as the hiatal hernia width, were investigated.

    Results Endoscopic findings indicating short white hair-like appendages in the lower esophagus were noted in 167 patients, with a prevalence rate of 1.2%. A female sex, younger age, lower body mass index, lower percentages of habitual smoking and drinking, and the presence of esophageal squamous papilloma were characteristic features of cases with such findings. In addition, a significantly lower prevalence of reflux esophagitis and a smaller diaphragmatic hiatus size were observed. A multiple logistic regression analysis indicated that a female sex, absence of reflux esophagitis, presence of esophageal squamous papilloma, and a smaller diaphragmatic hiatus were factors significantly related to the presence of these short white hair-like appendages. An analysis of circumferential localization revealed the main location to be the left-posterior wall.

    Conclusion This study is the first to report the prevalence of multiple short white hair-like appendages in the lower esophagus. The occurrence of such lesions is inversely associated with the presence of reflux esophagitis.

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  • Yukiko Hiramatsu, Takahiro Utsumi, Munehiro Ikeda, Hiroshi Seno
    Article ID: 3415-24
    Published: 2024
    Advance online publication: April 02, 2024
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  • Hiroko Okabayashi, Seiya Nakashima, Kosuke Fujino, Miyu Imai, Shohei H ...
    Article ID: 3418-23
    Published: 2024
    Advance online publication: April 02, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Anti-melanoma differentiation-associated gene 5 (MDA5) antibody-positive dermatomyositis (DM)-associated interstitial lung disease (ILD) can sometimes be complicated by pneumomediastinum, although tension pneumomediastinum is extremely rare. We herein report a case of anti-MDA5 antibody-positive DM-ILD that worsened subcutaneous and mediastinal emphysema during treatment. Hypotension and worsening respiratory failure were observed on day 20 of treatment. Mediastinal drainage under video-assisted thoracoscopic surgery promptly improved the patient's circulatory and respiratory status. Tension pneumomediastinum is a rare complication; however, it is a serious condition that may lead to hypotension or cardiac arrest and requires a prompt diagnosis and treatment.

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  • Yasutaka Tajima, Kosuke Iwami, Yasunori Mito
    Article ID: 3450-24
    Published: 2024
    Advance online publication: April 02, 2024
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  • Yuka Kowazaki, Hisashi Fukuda, Toyoaki Sawano, Masayuki Okazaki
    Article ID: 3514-24
    Published: 2024
    Advance online publication: April 02, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
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  • Takaaki Mori, Haruka Sato, Fumito Okada, Yoshiki Asayama
    Article ID: 3527-24
    Published: 2024
    Advance online publication: April 02, 2024
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  • Shinsuke Akiyama, Masaya Wada, Tetsuro Inokuma
    Article ID: 3557-24
    Published: 2024
    Advance online publication: April 02, 2024
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  • Yuzo Toyama, Ryuji Nagahama, Yu Kodama, Izumi Kaieda, Shingiro Sakai, ...
    Article ID: 2454-23
    Published: 2024
    Advance online publication: March 25, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    The patient was a 79-year-old male. At three years and eight months after his initial presentation, upper gastrointestinal endoscopy revealed a black-flattened elevated lesion in the middle third of the esophagus, which was diagnosed as malignant melanoma on biopsy. No lymph node or distant metastasis was found. A diagnosis of cT1bN0M0 Stage I was thus made. We performed a robot-assisted, minimally invasive esophagectomy and D2 dissection. The postoperative diagnosis was pT1a (MM), N0, M0, vascular invasion+, stage 0. The patient was recurrence-free for 14 months after surgery. We presume that an aggressive biopsy diagnosis is important for the early detection of malignant melanoma.

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  • Kemmyo Sugiyama, Toru Tsuboya, Seitaro Nakagawa, Toshihiro Kikuchi, Yu ...
    Article ID: 2881-23
    Published: 2024
    Advance online publication: March 25, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Home healthcare is important for allowing patients to live their lives. However, home-care bedridden patients often experience pressure ulcers in the lower extremities, which can lead to life-threatening infections requiring decisions on the need for amputation. We herein report a patient with an infected lower-limb pressure ulcer with a history of spinal injury. The patient, his family, and the home-care physician repeatedly shared decision-making to deliver home-based treatment instead of amputation. Administration of wound dressing, AQUACEL® Ag, led to complete epithelialization. Such shared decision-making and dressing were feasible in a home-care setting and broadened its scope.

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  • Suzuka Matsuoka, Keiichi Fujiwara, Yuki Takigawa, Saki Ito, Sho Mitsum ...
    Article ID: 3327-23
    Published: 2024
    Advance online publication: March 25, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    A 70-year-old woman with anti-aminoacyl-tRNA synthetase (ARS) antibody-positive interstitial lung disease (ARS-ILD) received daily medications and regular cyclophosphamide cycles for recurring exacerbations. Approximately four years after immunosuppression initiation, the patient was admitted for progressive dyspnea on exertion. Chest computed tomography (CT) findings were suggestive of acute exacerbation. Despite intensified immunosuppressive treatment, the radiographic findings worsened, and serum Krebs von den Lungen-6 (KL-6) levels increased. A bronchoalveolar lavage fluid (BALF) examination revealed amorphous globules and alveolar macrophages with eosinophilic granules. Owing to negative anti-GM-CSF antibody tests, a diagnosis of secondary pulmonary alveolar proteinosis (PAP) was established.

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  • Yohei Kita, Teppei Koyama, Shinji Machida, Naohiko Imai
    Article ID: 3335-23
    Published: 2024
    Advance online publication: March 25, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
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  • Kazuya Kojima, Kyoko Yagyu, Haruhiko Matsushita, Katsuyasu Ota
    Article ID: 3358-23
    Published: 2024
    Advance online publication: March 25, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    A 72-year-old man was admitted to our hospital with a complaint of breathlessness. Computed tomography (CT) revealed a tumor with intense early enhancement and pleural effusion. Although the pleural effusion was not bloody, the tumor showed a hypervascular area on angiography. Left thyrocervical artery embolization was performed to prevent bleeding during the operation. After embolization, chest radiography revealed decreased pleural effusion. The tumor was resected and pathologically diagnosed as a mediastinal cavernous hemangioma. To our knowledge, mediastinal hemangiomas with pleural effusion are extremely rare; thus, this is the first report of reduced pleural effusion in mediastinal hemangiomas after artery embolization.

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  • Masamitsu Hamakawa, Tadashi Ishida
    Article ID: 3531-24
    Published: 2024
    Advance online publication: March 25, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
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  • Aritoshi Kobayashi, Daisuke Miyagishima, Yusuke Ofuka, Toru Tsujibayas ...
    Article ID: 3558-24
    Published: 2024
    Advance online publication: March 25, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
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  • Nao Hanaki, Ryoto Sakaniwa, Takuhiro Moromizato, Jun Miyata, Keiko Ish ...
    Article ID: 2100-23
    Published: 2024
    Advance online publication: March 18, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Background Seasonal influenza affects healthcare demand. However, the efficacy of anti-influenza drugs, particularly among young patients at a low risk of complications, has rarely been evaluated. Therefore, we evaluated the efficacy of anti-influenza drugs against seasonal influenza in healthy young and middle-aged adults.

    Methods A systematic review and network meta-analysis were conducted. The Cochrane Central Register of Controlled Trials and Medical Literature Analysis and Retrieval System Online were searched for original articles reporting double-blind, randomized controlled trials published up to the end of July 2023. Clinical trials that tested the efficacy of anti-influenza drugs in young and middle-aged patients with seasonal influenza were also included. The primary outcome was time to fever alleviation. The efficacy and adverse effects of these treatments were estimated using a Bayesian hierarchical random-effects model and a Markov chain Monte Carlo simulation.

    Results In total, 24 articles with 34 treatments and 8,949 individuals were included. Oseltamivir (300 mg/day for 5 days) showed the largest reduction in time to fever alleviation by -19.1 (95% confidence interval [CI]: -29.4, -10.7) h compared with a placebo. Baloxavir marboxil (40 mg/day) reduced the time to symptom alleviation by -28.2 (95% CI: -42.7, -13.7) h, and peramivir (300 mg/day) administered by intravenous infusion for 1 day reduced the time to resumption of usual activities by -43.5 (95% CI: -72.8, -14.2) h.

    Conclusion Several pharmaceutical treatments were able to reduce the recovery time for fever and symptom alleviation and resumption of usual activities in young and middle-aged adults with seasonal influenza without increasing the risk of complications.

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  • Fumiya Kaneko, Hiroshi Suzuka, Tomoaki Yoshino, Ryosuke Hinosugi
    Article ID: 2487-23
    Published: 2024
    Advance online publication: March 18, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Objective Elotuzumab plus lenalidomide and dexamethasone (ELd) was approved in Japan in 2016 for the treatment of relapsed/refractory multiple myeloma (RRMM). This post-marketing surveillance study evaluated the safety and effectiveness of ELd in RRMM patients during routine clinical practice in Japan.

    Methods Elotuzumab safety was assessed by evaluating adverse drug reactions (ADRs), and effectiveness was assessed primarily by the best overall response.

    Patients The study enrolled patients with RRMM who received ELd therapy between November 18, 2016, and June 18, 2017. The safety and effectiveness analysis sets included 831 and 755 patients, respectively.

    Results In the safety analysis set, patients received a median (range) of 12 (1-40) elotuzumab administrations over 108 (1-728) days of treatment. The relative dose intensity of elotuzumab was ≥90% in 74.1% of patients. ADRs and serious ADRs were reported in 41.2% and 15.2% of the patients, respectively. The most common ADR was infection (12.0%), followed by lymphocytopenia (10.1%), infusion reactions (7.5%), secondary malignancies (e.g. gastric cancer and pancreatic carcinoma), cataracts, and interstitial lung disease (0.2% each). While most patients with ADRs recovered, 71 discontinued treatment, and 14 deaths were reported. The presence of comorbidities, particularly cardiovascular disorders, significantly affected the safety. The overall response rate was 41.1%.

    Conclusion This all-case post-marketing surveillance study showed that ELd had an acceptable tolerability profile and promising clinical activity in Japanese patients with RRMM.

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  • Haruka Imai, Jun Suzuki, Shota Takahashi, Daishi Shimada, Makiko Yoshi ...
    Article ID: 3266-23
    Published: 2024
    Advance online publication: March 18, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Objective To survey the epidemiology of respiratory pathogens during the COVID-19 pandemic using multiplex polymerase chain reaction (PCR).

    Methods Specimens were assayed using multiplex nested PCR.

    Patients and Materials Specimens were obtained from outpatients who presented with symptoms of upper respiratory tract infection and asymptomatic outpatients who had contact with patients with SARS-CoV-2 infection at Tohoku Medical and Pharmaceutical University Hospital in Sendai, Japan, from November 1, 2020, to May 31, 2023. The analysis included multiple specimens collected from the same patients at different time-points. Data were collected from the electronic records after testing.

    Results This study included 8,335 patients (4,311 men) with a median age of 59 years old, and 11,741 total specimens were collected. At least 1 positive SARS-CoV-2 result was obtained for 1,710 (14.6%) specimens. Furthermore, 15 pathogens were identified in the positive specimens, and rhinovirus/enterovirus was detected more frequently than other viruses. We identified a larger number of SARS-CoV-2-positive specimens in patients ≥10 years old. In contrast, in patients 0-9 years old, we identified a larger number of specimens positive for rhinovirus/enterovirus than for other viruses.

    Conclusions In this study, we examined the epidemiology of circulating respiratory pathogens during the COVID-19 pandemic era.

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  • Monami Tarisawa, Masaaki Matsushima, Akihiko Kudo, Ken Sakushima, Yasu ...
    Article ID: 3275-23
    Published: 2024
    Advance online publication: March 18, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Objective In 2022, Wenning et al. proposed the Movement Disorder Society Criteria (MDS Criteria) for the Diagnosis of Multiple System Atrophy (MSA). These criteria were expected to provide useful alternatives to the second consensus statement. We examined trends in these diagnostic criteria.

    Methods We used patient data registered with the Hokkaido Rare Disease Consortium for Multiple System Atrophy, which has been recruiting patients with MSA through medical facilities in Hokkaido since November 2014. Patients were evaluated according to the MDS criteria based on neurological examinations and imaging findings at three separate times: the first evaluation, the time of enrollment (diagnosis), and the most recent evaluation (final evaluation).

    Results The MDS criteria were examined in 68 of 244 patients enrolled between November 2014 and July 2022. At the initial evaluation, the classifications were as follows: clinically established (n=27; 39.7%); clinically probable (n=13; 19.1%); possible prodromal (n=12; 17.6%); and negative (did not meet criteria (n=16; 23.5%). At the time of diagnosis, the classifications were as follows: clinically established (n=45; 66.2%); clinically probable (n=12; 17.6%); possible prodromal (n=4; 5.9%); and negative (n=7; 10.3%). At the final evaluation, the classifications were as follows: clinically established (n=52; 76.5%); clinically probable (n=9; 13.2%); possible prodromal (n=2; 2.9%); and negative (n=5; 7.4%).

    Conclusions We were able to clarify the changes in the criteria values and transition of patients due to the clarification of imaging and supportive findings in the MDS criteria.

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  • Haruka Maruyama, Shadia Constantine
    Article ID: 3289-23
    Published: 2024
    Advance online publication: March 18, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
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  • Norihiko Terada, Taku Sawafuji
    Article ID: 3383-23
    Published: 2024
    Advance online publication: March 18, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
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  • Shogo Komaki, Akatsuki Kubota, Kazuto Katsuse, Asuka Kitamura, Meiko M ...
    Article ID: 3435-23
    Published: 2024
    Advance online publication: March 18, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Calpainopathy is primarily an autosomal recessive inherited myopathy; however, dominantly inherited cases with a pathogenic variant of c.1333G>A have been reported. A 13-year-old Japanese girl presented with toe walking and elevated serum creatine kinase levels. Genetic panel testing revealed compound heterozygosity for c.1333G>A and a novel variant of c.1331C>T in CAPN3, leading to a diagnosis of calpainopathy. A genetic analysis of her parents revealed the possibility that c.1333G>A was de novo. In this patient, the onset age was earlier than that of the reported autosomal dominant cases, suggesting the influence of the novel variant in the contralateral allele.

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