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Internal Medicine

Katsuhito Ihara, Atsuki Ohashi, Seiji Inoshita
Heparin is commonly used to prevent clotting; however, severe hypersensitivity reactions during vascular access (VA) placement are rarely but occasionally reported. A 49-year-old man experienced a heparin-induced hypersensitivity reaction during VA placement. Severe side effects may occur even while placing the VA; therefore, we reconsidered the routine use of heparin, as the side effects are unpredictable. Physicians should be aware of the risk of heparin-induced hypersensitivity and be ready to effectively manage it during VA placement...
March 9, 2018: Internal Medicine
Takashi Komatsu, Fusanori Kunugita, Mahito Ozawa, Yoshihiro Satoh, Reisuke Yoshizawa, Shingen Owada, Youhei Sawa, Yoshihiro Morino, Motoyuki Nakamura
Background and methods There is little information concerning the influence of the heart rhythm on the vascular endothelial function in patients with non-valvular atrial fibrillation (AF) compared with studies concerning sinus rhythm (SR). The present study included paroxysmal (n=184) or chronic (n=53) AF patients without heart failure and control subjects with SR (n=79) matched for age, gender and the CHA2 DS2 -VASc score. Paroxysmal AF was defined as episodes that terminated spontaneously within 7 days, while chronic AF was defined as longstanding AF that was refractory to cardioversion for 12 months or longer...
March 9, 2018: Internal Medicine
Shinya Sakata, Yasumiko Sakamoto, Akira Takaki, Shiho Ishizuka, Sho Saeki, Kazuhiko Fujii
Pseudomesotheliomatous carcinoma of the lung is very rare, and reversible restrictive lung disease with pseudomesotheliomatous carcinoma has not yet been previously reported. We herein report a patient with HER2-positive non-small-cell lung cancer (NSCLC) showing pseudomesotheliomatous carcinoma who was successfully treated with bevacizumab combination chemotherapy. A 56-year-old Japanese woman with advanced NSCLC presented with dyspnea. We administered chemotherapy with cisplatin (75 mg/m2 ) plus pemetrexed (500 mg/m2 ) plus bevacizumab (15 mg/kg), followed by pemetrexed plus bevacizumab...
March 9, 2018: Internal Medicine
Fumiaki Kudo, Yasutaka Watanabe, Yuki Iwai, Chihiro Miwa, Yoshiaki Nagai, Hiromitsu Ota, Hiroki Yabe, Toshio Demitsu, Koichi Hagiwara, Nobuyuki Koyama, Shinichiro Koyama
We herein report a 42-year-old man with advanced lung adenocarcinoma and nivolumab-associated dermatomyositis. Nivolumab, an anticancer drug that is classified as an immune checkpoint inhibitor, often induces immune-related adverse events (irAEs). However, there have so far been no reports regarding nivolumab-associated dermatomyositis. This patient was diagnosed with dermatomyositis due to the presence of proximal muscle weakness with abnormal electromyography and magnetic resonance imaging findings; skin lesions, such as heliotrope rash, shawl sign, and periungual erythema; and an elevated serum aldolase level after nivolumab administration...
March 9, 2018: Internal Medicine
Yo Seino, Takashi Hasegawa, Toshiyuki Koya, Takuro Sakagami, Ichiro Mashima, Natsue Shimizu, Yoshiyuki Muramatsu, Kumiko Muramatsu, Eiichi Suzuki, Toshiaki Kikuchi
Objective Whether or not depression affects the control or severity of asthma is unclear. We performed a cluster analysis of asthma patients with depressive symptoms to clarify their characteristics. Methods and subjects Multiple medical institutions in Niigata Prefecture, Japan, were surveyed in 2014. We recorded the age, disease duration, body mass index (BMI), medications, and surveyed asthma control status and severity, as well as depressive symptoms and adherence to treatment using questionnaires. A hierarchical cluster analysis was performed on the group of patients assessed as having depression...
March 9, 2018: Internal Medicine
Kenichiro Tanaka, Hideaki Senjyu, Yuichi Tawara, Takako Tanaka, Masaharu Asai, Mitsuru Tabusadani, Sumihisa Honda, Terumitsu Sawai, Ryo Kozu
Objective The early detection and treatment of COPD requires comprehensive follow-up over a long period. The aim of this study was to determine the effects of a comprehensive long-term intervention system developed by the COPD Task Force for a rural city in Japan during a 7-year period. Methods This prospective, community-based longitudinal study encompassed 2006-2013 in Matsuura City, Japan. Primary and secondary screenings were performed for the early diagnosis and treatment of COPD. Individuals diagnosed with COPD were managed by the COPD Task Force's comprehensive early intervention system...
March 9, 2018: Internal Medicine
Sho Kitagawa, Daiki Oku, Keiya Okamura
No abstract text is available yet for this article.
March 9, 2018: Internal Medicine
Katsunori Matsueda, Tatsuya Toyokawa, Masahiro Sakata, Isao Fujita, Jouichiro Horii
This case report refers to a 31-year-old patient with an 11-year history of Crohn's disease. The patient presented with an edematous elevated lesion in the splenic flexure. Two histological analyses revealed no signs of obvious dysplasia, and the patient subsequently began infliximab treatment. Nine months later, a worsening of the stricture of the edematous elevated lesion was observed in the splenic flexure, and transverse colonic resection was performed. A histological investigation of the lesion in the splenic flexure revealed advanced adenocarcinoma...
March 9, 2018: Internal Medicine
Yuta Ito, Shinichi Makita, Akiko Miyagi Maeshima, Shunsuke Hatta, Tomotaka Suzuki, Sayako Yuda, Suguru Fukuhara, Wataru Munakata, Tatsuya Suzuki, Dai Maruyama, Koji Izutsu
Paraneoplastic pemphigus (PNP) is a severe autoimmune blistering disease associated with an underlying malignancy, and its prognosis is poor. We herein report the first patient with B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma (B-CLL/SLL)-associated PNP successfully treated with the Bruton's tyrosine kinase inhibitor ibrutinib and rituximab. Although his PNP lesions did not improve with ibrutinib monotherapy, the combination of ibrutinib and rituximab was effective against B-CLL/SLL-associated PNP...
March 9, 2018: Internal Medicine
Satoshi Ichikawa, Noriko Fukuhara, Shunsuke Hatta, Masahito Himuro, Hiroki Katsushima, Kentaro Nasu, Koya Ono, Kyoko Inokura, Masahiro Kobayashi, Yasushi Onishi, Hiroshi Fujii, Kenichi Ishizawa, Ryo Ichinohasama, Hideo Harigae
A 16-year-old boy, who had been initially examined for bilateral blepharedema and slight eruption, presented with rapidly deteriorating symptoms in associating with headache and consciousness disturbance. He was diagnosed to have primary cutaneous CD8-positive aggressive epidermotropic cytotoxic T-cell lymphoma (PCAE-CTL) by a biopsy of the skin and brain. After whole-brain radiation and some courses of chemotherapy, cord blood transplantation was performed with myeloablative conditioning. After transplantation, the cerebral dysfunction gradually improved...
March 9, 2018: Internal Medicine
Yuji Eso, Norimitsu Uza, Kotaro Shirakawa, Kenji Sawada, Kentaro Katsuragi, Minoru Matsuura, Hiroshi Seno
We herein report a patient with a history of rheumatoid arthritis treated with methotrexate, which caused methotrexate-associated lymphoproliferative disorder and obstructive jaundice due to an enlarged lymph node. The obstructive jaundice was treated with endoscopic biliary stenting. A histopathological examination revealed features of Hodgkin's lymphoma, and chemotherapy with brentuximab vedotin was administered. Cholangiography and duodenoscopy after four rounds of chemotherapy revealed a choledochoduodenal fistula that developed in response to chemotherapy...
March 9, 2018: Internal Medicine
Fumiko Kawasaki, Takatoshi Anno, Maiko Takai, Shintaro Irie, Hideaki Kaneto, Kohei Kaku, Niro Okimoto
Type B insulin resistance syndrome is a rare autoimmune disease and no effective therapy has yet been established. On the other hand, it is known that Saibokuto, one type of Japanese Kampo medicine, may have beneficial effects on various symptoms associated with this disease and it is therefore occasionally prescribed for various immune disorders. We herein describe a case of type B insulin resistance syndrome in which anti-insulin receptor antibody disappeared and the patient's glycemic control markedly improved after the administration of Saibokuto...
March 9, 2018: Internal Medicine
Kazuhiko Morii, Takeharu Yamamoto, Shinichiro Nakamura, Hiroaki Okushin
Objective An infectious hepatic cyst (IHC) is a hepatic cyst complicated with secondary infection and is generally assumed to be rare. However, we have experienced no small number of patients with IHC in recent clinical practice. We therefore examined the incidence and clinical characteristics of IHC. Methods The medical records of patients with IHC who were hospitalized at our institution between January 2012 and December 2016 were retrospectively reviewed. Their demographic factors, biochemical, bacteriological, imaging, and treatment results were explored and compared with those of patients with pyogenic liver abscess (PLA)...
March 9, 2018: Internal Medicine
Shusuke Yagi, Yousuke Yamamoto, Seiichi Nishiyama, Masataka Sata
No abstract text is available yet for this article.
March 9, 2018: Internal Medicine
Kentaro Minami, Koji Kumagai, Yoshinao Sugai, Kohki Nakamura, Shigeto Naito, Shigeru Oshima
A 19-year-old man was referred due to sudden onset of right foot pain and chest discomfort. Contrast-enhanced computed tomography revealed massive thrombi in the right pulmonary artery and femoral vein. The patient's father had experienced multiple recurrences of venous thromboembolism (VTE) and was diagnosed with inherited antithrombin deficiency by a genetic examination. The patient was administered the oral factor Xa inhibitor rivaroxaban (30 mg). After seven days, the thrombus disappeared. Rivaroxaban (15 mg) was continued for 6 months with no recurrence, indicating the efficacy of this factor Xa inhibitor for the treatment and prevention of VTE in patients with antithrombin deficiency...
March 9, 2018: Internal Medicine
Toshihiko Komai, Shuji Sumitomo, Shuzo Teruya, Keishi Fujio
A 76-year-old man complicated with end-stage renal disease had latent tuberculosis infection (LTBI), and isoniazid (INH) 300 mg daily was started to prevent reactivation of LTBI before using biologic agents for rheumatoid arthritis. On the 8th day after administration of INH, he presented with a fever, petechiae, and myalgia. Serological studies revealed elevated myogenic enzymes and creatinine level. Based on the exclusion of other etiologies, rapid improvement with cessation of INH, and the recurrence of the fever and myalgia with re-administration of a reduced dose of INH, we diagnosed him with INH-induced rhabdomyolysis...
March 9, 2018: Internal Medicine
Satoshi Takakusagi, Ken Sato, Yuhei Suzuki, Yuichi Yamazaki, Takashi Kosone, Satoru Kakizaki, Motoyasu Kusano, Hitoshi Takagi
We herein report a unique case of hepatitis C virus (HCV)-associated renal disease without cryoglobulinemia that showed proteinuria, hypoproteinemia, ascites, and edema. Due to combination therapy with daclatasvir and asunaprevir, the patient achieved sustained virological response at week 24 of the therapy. Furthermore, the therapy caused marked amelioration of her proteinuria, ascites, edema, and hypoalbuminemia, and finally improved her estimated glomerular filtration rate. There were no adverse events, and the combination therapy was well-tolerated...
March 9, 2018: Internal Medicine
Kazuhiro Toyama, Atsushi Yasumoto, Fumihiko Nakamura, Shunya Arai, Mineo Kurokawa
Acquired hemophilia A (AHA) is a hemorrhagic disorder. Whether or not severe thrombotic events can develop without the use of bypassing agents in AHA patients is unclear. An 80-year-old woman with AHA underwent immunosuppressive therapy with prednisolone at 1 mg/kg daily. After achieving remission, she suddenly developed multiple organ failure due to acute systemic thrombosis and died within a few hours of the diagnosis. Patients with AHA, especially those with risk factors for thrombosis, have a considerable risk of developing thrombosis during the recovery phase of factor VIII activity and should be carefully monitored by coagulation testing...
March 9, 2018: Internal Medicine
Keisuke Kakisaka, Kei Endo, Ryo Sugimoto, Kazuyuki Ishida, Tamotsu Sugai, Yasuhiro Takikawa
Intrahepatic cholangiocarcinoma (ICC) is the second-most common primary liver cancer, although its occurrence is relatively rare. Budd-Chiari syndrome (BCS) is characterized by outflow obstruction from the liver, with hepatocellular carcinoma being the most common cause of malignant BCS. In this case report, we describe the occurrence of an unrecognized ICC that induced BCS and esophageal achalasia.
March 9, 2018: Internal Medicine
Hiroyuki Fukuda, Akira Tanaka, Yasuyuki Hirashima, Ichiro Ito
Lambert-Eaton myasthenic syndrome (LEMS) is most commonly associated with small cell lung carcinoma, while it is rarely associated with gynecological and breast carcinoma. We herein report a case of LEMS associated with synchronous double cancer, which was a combination of small cell carcinoma of the cervix and breast carcinoma. The early diagnosis and treatment of LEMS are important for achieving a good outcome. The possibility of accompanying paraneoplastic neurological syndrome must be sufficiently considered in gynecology and breast cancer patients...
March 9, 2018: Internal Medicine
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