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Internal Medicine

Takashi Matsuyama, Naro Ohashi, Sayaka Ishigaki, Shinsuke Isobe, Naoko Tsuji, Tomoyuki Fujikura, Takayuki Tsuji, Akihiko Kato, Hiroaki Miyajima, Hideo Yasuda
Objective The mechanisms underlying the intrarenal renin-angiotensin system (RAS) activation depend on the conditions of kidney diseases. In angiotensin II (AngII) infusion models, the circulating AngII is filtered into the renal tubular lumens, activating intrarenal RAS. However, in the chronic kidney disease (CKD) models, plasma angiotensinogen (AGT) is filtered into the tubular lumens because of glomerular injury, activating intrarenal RAS. The intrarenal dopamine system activation reduces intrarenal AGT expression and suppresses the intrarenal RAS activity in AngII infusion models...
July 6, 2018: Internal Medicine
Yushi Kawaguchi, Hideki Mori, Yasumori Izumi, Masahiro Ito
No abstract text is available yet for this article.
July 6, 2018: Internal Medicine
Hideyuki Nakazawa, Sayaka Nishina, Hitoshi Sakai, Toshiro Ito, Fumihiro Ishida, Kiyoshi Kitano
Asplenia may yield an increased risk of fulminant sepsis with various pathogens. Human infection with Campylobacter fetus is rare, but it often presents with non-gastrointestinal tract infection among immunocompromised individuals. A 55-year-old abattoir worker presented with a fever. He had had splenectomy for follicular lymphoma and rituximab maintenance therapy by four months before the presentation. Blood cultures yielded C. fetus, and the administration of meropenem dissolved the bacteremia. Further maintenance therapy was withheld, and no recurrence of infection has been observed for seven years...
July 6, 2018: Internal Medicine
Masahiro Yamasaki, Masaya Taniwaki, Naoko Deguchi, Noboru Hattori
No abstract text is available yet for this article.
July 6, 2018: Internal Medicine
Luca Foppiani
Syndrome of inappropriate antidiuretic hormone (SIADH) secretion is the most common cause of hypotonic hyponatremia in hospitalized patients. An elderly man with severe symptomatic hyponatremia (109 mEq/L) was diagnosed with SIADH that was likely secondary to large cutaneous herpes zoster (HZ) infection. Hypertonic saline and tolvaptan improved the patient's sodium levels and clinical condition. A one month after discharge, tolvaptan was withdrawn, due to inadequate prescription criteria, after which hyponatremia relapsed several times and was properly treated; eventually fever and sopor occurred and the patient died...
July 6, 2018: Internal Medicine
Yoshiaki Zaizen, Takaaki Tokito, Ken Masuda, Koichi Azuma, Yoshiki Naito, Shingo Tsuneyoshi, Yuki Sakzaki, Norikazu Matsuo, Hidenobu Ishii, Kazuhiko Yamada, Jun Akiba, Tomoaki Hoshino
There have been few reports on the accuracy of the diagnosis of small-cell carcinoma based on a cytological examination of malignant pleural effusion, so whether or not such a diagnosis is possible using this approach alone remains unclear. We herein report a 76-year-old Japanese man in whom small-cell carcinoma was diagnosed cytopathologically from pleural effusion and squamous cell carcinoma was diagnosed histopathologically from a transbronchial biopsy. Tumor shrinkage was achieved by treatment with docetaxel, but the efficacy of carboplatin plus etoposide was inadequate...
July 6, 2018: Internal Medicine
Nobuhiro Kanaji, Kodai Kume, Hitoshi Mizoguchi, Takuya Inoue, Naoki Watanabe, Noriko Nishiyama, Norimitsu Kadowaki, Tomoya Ishii
A 66-year-old man presented with subacute sensorimotor neuropathy in association with small cell lung cancer. Tests for the anti-ganglioside antibody GM1-IgM were positive. Chemotherapy and intravenous immunoglobulin treatment led to a slight improvement in neurological symptoms. Four additional cases of neuropathy accompanied by anti-ganglioside antibody and lung cancer have been reported. The most commonly reported pattern was subacute sensorimotor neuropathy. Patients died from cancer progression after 5 to 18 months...
July 6, 2018: Internal Medicine
Kenichi Komatsu, Hiroki Toda, Sadayuki Matsumoto
Plexiform schwannoma is a rare variant of schwannomas and usually presents with chronic symptoms. We herein report a case of cervical nerve plexiform schwannoma that presented with unusually sudden severe left radiculopathy of the eighth cervical nerve after physical exercise. Coronal short-tau inversion recovery (STIR) magnetic resonance imaging (MRI) revealed a multinodular tumor along the eighth cervical nerve. The tumor was partially resected. A pathological analysis revealed that the tumor was a schwannoma, and we diagnosed the case as a plexiform schwannoma...
July 6, 2018: Internal Medicine
Kokoro Ozaki, Takuya Ohkubo, Tetsuo Yamada, Kotaro Yoshioka, Masahiko Ichijo, Takamasa Majima, Shunsuke Kudo, Takumi Akashi, Keiji Honda, Eisaku Ito, Mayumi Watanabe, Masaki Sekine, Miwako Hamagaki, Yoshinobu Eishi, Nobuo Sanjo, Satoru Ishibashi, Hidehiro Mizusawa, Takanori Yokota
Progressive encephalomyelitis with rigidity and myoclonus (PERM) is an autoimmune disorder involving the brainstem and spinal cord and is sometimes associated with thymoma. We encountered a 75-year-old woman with typical PERM features, glycine receptor antibody, and thymoma. Her neurologic symptoms improved after thymectomy, but she unexpectedly developed anasarca with massive pleural effusions and hypoalbuminemia and finally succumbed to death. The autopsy showed edema and mononuclear infiltration in the pleura but no neuropathological findings typical of PERM...
July 6, 2018: Internal Medicine
Haruki Koike, Tomohiko Nakamura, Ryoji Nishi, Shohei Ikeda, Yuichi Kawagashira, Masahiro Iijima, Masahisa Katsuno, Gen Sobue
Objective The autonomic functions of hereditary transthyretin (ATTRm) amyloidosis, traditionally referred to as familial amyloid polyneuropathy, have primarily been investigated in patients with Val30Met mutations, and information regarding non-Val30Met patients is scarce. The aim of this study was to systematically investigate the cardiac and peripheral vasomotor autonomic functions in non-Val30Met patients. Methods The coefficient of variation of R-R intervals (CVR-R), responses to the Valsalva manoeuvre, head-up tilt test results, noradrenaline infusion test results, and the (123) I-metaiodobenzylguanidine (MIBG) uptake on myocardial scintigraphy were assessed in five patients...
July 6, 2018: Internal Medicine
Hidefumi Suzuki, Tadashi Kitagawa, Masahiro Gotoh, Takahiro Mitsueda-Ono, Masaru Matsui
Cervical cord infarction is uncommon but has been increasingly reported as a complication of vertebral artery dissection (VAD). A 54-year-old woman presented with neck pain and neurological deficit following sudden neck movement. Radiological findings suggested cervical cord infarction in the anterior spinal artery territory at the C5-C6 vertebral level and dissection of the intracranial segment of the right vertebral artery. Cervical cord infarction due to VAD is usually caused by dissection of its extracranial segment...
July 6, 2018: Internal Medicine
Kiyotaka Nakamagoe, Hisami Yanagiha, Zenshi Miyake, Yuya Kondo, Takashi Hiyama, Akiko Ishii, Yuichi Kaji, Tetsuro Oshika, Takayuki Sumida, Akira Tamaoka
We herein report the case of a patient who developed peripheral neuropathy of the bilateral lower legs that later became complicated with isolated oculomotor nerve disorder and was finally diagnosed as systemic lupus erythematosus (SLE). Based on the findings for oculomotor nerve paralysis and contrast-enhanced magnetic resonance imaging findings for the oculomotor nerve in the prepontine cistern, the isolated oculomotor nerve disorder was considered to be a manifestation of peripheral neuropathy. This oculomotor nerve disorder may contribute to the diagnosis of SLE and can be effectively treated with steroid pulse therapy...
July 6, 2018: Internal Medicine
Eisuke Adachi, Yuta Miharu, Masato Suzuki, Hiroshi Yotsuyanagi
No abstract text is available yet for this article.
July 6, 2018: Internal Medicine
Hajime Sasano, Akimasa Sekine, Toru Hirata, Keisuke Iwamoto, Yuhei Itou, Hidetoshi Itani, Shigeto Kondou, Toshiya Tokui, Motoaki Tanigawa
We herein report a 37-year-old woman with lung adenocarcinoma with brain metastases and an asymptomatic ovarian tumor. Immunohistochemistry and a fluorescent in situ hybridization analysis of the biopsied lung tumor revealed ALK gene rearrangement. Although the origin of the ovarian tumor remained unclear, alectinib administration was initiated, and radiological responses were observed in all lesions, which confirmed that the ovarian tumor was a metastasis from lung cancer. Although differentiating the origin of an ovarian tumor is difficult in lung cancer patients due to the rarity of ovarian metastases, alectinib therapy can replace an invasive biopsy, especially in ALK-rearranged lung cancer patients...
July 6, 2018: Internal Medicine
Norie Takei, Takeshige Kunieda, Yoshitaka Kumada, Masanori Murayama
A 79-year-old man with appetite loss and nausea for 1 month was admitted to our hospital. His thoracic aortic aneurysm had gradually increased in size due to perigraft endoleak after the previous aneurysm repair surgery. Although he showed no hematemesis, melena, or a fever, gastrointestinal endoscopy and contrast-enhanced computed tomography (CT) revealed an aortoesophageal fistula (AEF). He developed septic shock due to a perigraft abscess and eventually died, although aortic graft replacement and esophageal transection were performed...
July 6, 2018: Internal Medicine
Takehiko Kobayashi, Kazunari Tsuyuguchi, Takahiko Kasai, Katsuhiro Suzuki
Tuberculosis may be accompanied by various hematological abnormalities during treatment, and occasionally thrombocytopenia is also noted. Most cases of thrombocytopenia in tuberculosis are moderate, and there are few reports about thrombocytopenia with diffuse alveolar hemorrhaging (DAH) in pulmonary tuberculosis. We describe the case of an 82-year-old man with pulmonary tuberculosis and tuberculous pleurisy. He underwent anti-tuberculosis chemotherapy; during tuberculosis treatment, he experienced DAH due to fulminant thrombocytopenia...
July 6, 2018: Internal Medicine
Arifumi Matsumoto, Kinya Hisanaga, Isao Nagano
No abstract text is available yet for this article.
July 6, 2018: Internal Medicine
Shoichiro Kitajima, Susumu Mizuno, Ryo Kogiso, Chiaki Tsuji
No abstract text is available yet for this article.
July 6, 2018: Internal Medicine
Katsutoshi Sugimoto, Fuminori Moriyasu, Takayoshi Tsuchiya, Yuichi Nagakawa, Yuichi Hosokawa, Kazuhiro Saito, Akihiko Tsuchida, Takao Itoi
OBJECTIVE: To evaluate irreversible electroporation (IRE) for locally advanced pancreatic cancer (LAPC). MATERIALS AND METHODS: This study was approved by our local review board. Eight patients with histologically proven LAPC≤5 cm were prospectively enrolled to undergo ultrasound-guided IRE. The primary endpoint was complications within 90 days. Secondary outcomes were the overall survival (OS) and time to local progression. Safety was assessed using Common Terminology Criteria for Adverse Events Version 4...
July 6, 2018: Internal Medicine
Yasuo Zenimaru, Mika Yamada, Jinya Suzuki, Tadashi Konoshita
No abstract text is available yet for this article.
July 6, 2018: Internal Medicine
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