Digestive diseases and digestive symptoms are among the most universal diseases in everyday clinical care. However, digestive diseases accompanying rheumatic and connective tissue diseases are often onset with a background of complicated pathologies. Therefore, it is necessary to distinguish these at an early stage and carry out treatment according to the pathology. It is necessary to give specialized support upon precise medical interviews and physical examinations along with making diagnoses by standard clinical and graphic examinations.

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Lambert-Eaton myasthenic syndrome (LEMS) is an auto-immune disorder caused by neuromuscular transmission failure, and is a representative pre-neuromuscular junctional disorder. The auto-immune antibody is anti-P/Q-type voltage-gated calcium channel (P/Q-type VGCC) antibody detected in approximately 80 to 90% of LEMS patients. Approximately 60% of LEMS patients have small cell lung cancer (SCLC), approximately 10% of patients have other malignant tumors, and the remaining 30% have no malignancy. Thus, the therapeutic strategy for LEMS depends on the presence of a malignant tumor. LEMS with a malignant tumor is also considered to be a representative paraneoplastic neurological syndrome. Recently, new chemotherapeutic drugs for malignant tumors including SCLC have been developed. In cases with no malignancy, several new immune-mediated therapies have become available. Therefore, we can expect improved therapeutic responses for this disorder.

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A 33-year-old woman was transferred to our hospital for an unresolving pneumonia, who initially presented with dyspnea. Initially antibiotic therapy was started under the suspicion of community-acquired pneumonia, however, her respiratory status worsened at the previous hospital. Computed tomography (CT) on presentation showed peripheral ground glass opacities in both sides of the upper lobe. Also despite additional prednisolone therapy, her respiratory status worsened.

On admission to our hospital, physical examination showed Gottoron’s sign in her right elbow. From the nature of the rash, the absence of myositis symptoms and rapid respiratory worsening, we suspected clinically amyopathic dermatomyositis (CADM). After the triple drug therapy, her respiratory status improved.

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Background: In general practice, a wide variety of patients often present with various complaints. Some of them have multiple somatic symptoms, and it is possible for a general practitioner to miss an organic disease. In this cross-sectional study, we retrospectively examined the correlation between the number of complaints and the prevalence of diseases in order to elucidate clues to help detect organic diseases in patients with multiple somatic complaints.
Method: We evaluated 386 new walk-in outpatients who presented to the department of general medicine at the Toyama University Hospital between January 2014 and December 2014 with pain symptoms. Symptoms were classified by the number of pain sites (NPS) and the number of other non-pain complaints (NOC). Then we examined the association between these two variables and the final diagnosis.
Results: The prevalence of organic diseases in the four and more NPS group was significantly higher than that of the three or less NPS group (66.7% and 27.5%, respectively). Psychiatric diseases were more prevalent in the group who had three and more NOC than in the patient population with two or less NOC (36.4% and 4.4%, respectively).
Conclusion: Counting NPS and NOC could contribute to proper management of patients with multiple somatic complaints.

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A 76-year-old-man was admitted to hospital because of fever and back pain. Blood cultures yielded extended-spectrum beta-lactamase-producing Escherichia coli (ESBLEC). We suspected pyogenic vertebral osteomyelitis (PVO) secondary to urosepsis. However, magnetic resonance imaging (MRI) of the lumbar spine did not reveal findings of PVO. The extent of tenderness in the back converged on the lumbar spine on repeated physical examinations. We decided to perform a second MRI, and it showed hypointensity on T1-weighted images and contrast enhancement in L3/L4. Culture of computed tomography guided L3/L4 disc biopsy yielded ESBLEC. Daily repeated physical examinations contributed to the correct diagnosis.

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Objective: This hospital-based study examined whether outpatient cardiac rehabilitation (CR) prevents cardiac-related re-admission within 6 months.
Method: Clinical records of Japanese cardiac disease patients who were hospitalized and recommended for cardiac rehabilitation at a general hospital were analyzed by comparing data from 78 outpatient CR (OCR) participants with data from 179 randomly selected non-participants.
Results: OCR significantly prevented cardiac-related re-admission (odds ratio: 0.24; 95% confidence interval: 0.06–0.91) after controlling for sex and OCR participation-associated factors.
Conclusion: OCR participation may improve short-term prognosis. The positive effects of OCR should be promoted to increase participation.

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