Relationship between Snoring and Lifestyle-related Diseases among a Japanese Occupational Population.
Conclusion Snoring was shown to be a frequent pathophysiology in active workers. It was a health indicator for active workers, and especially in men, intervention for snoring may reduce the risk of developing lifestyle-related diseases. PMID: 32938849 [PubMed - in process] (Source: Internal Medicine)
Source: Internal Medicine - September 18, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

Clinical Utility of the Meal Tolerance Test in the Care of Patients with Type 2 Diabetes Mellitus.
Conclusion The plasma C-peptide levels at 0 and 120 minutes in the MTT provide essential information for the clinical management of patients with type 2 diabetes mellitus. PMID: 32938850 [PubMed - in process] (Source: Internal Medicine)
Source: Internal Medicine - September 18, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

Chronotherapy with a Renin-angiotensin System Inhibitor Ameliorates Renal Damage by Suppressing Intrarenal Renin-angiotensin System Activation.
Conclusion This study indicated that chronotherapy with RAS inhibitors improved the renal damage via intrarenal RAS suppression, especially in CKD patients with an impaired renal function and nocturnal hypertension. PMID: 32938851 [PubMed - in process] (Source: Internal Medicine)
Source: Internal Medicine - September 18, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

A Rare Case of Ectopic Adrenocorticotropic Hormone Syndrome with Recurrent Olfactory Neuroblastoma.
Authors: Abe H, Suwanai H, Kambara N, Sano K, Shikuma J, Akaoka H, Kanazawa A, Hirai H, Miwa T, Nagao T, Odawara M Abstract A 40-year-old woman who had a history of recurrent olfactory neuroblastoma presented with full moon face, central obesity, buffalo hump, impaired glucose tolerance and bilateral cervical lymph node swelling. Laboratory tests showed morbidly elevated levels of ACTH and cortisol, which were not suppressed by high-dose (8 mg) dexamethasone. Biopsies of the enlarged cervical lymph nodes revealed adrenocorticotropic hormone (ACTH)-positive metastatic olfactory neuroblastoma, and ectopic ACTH syndro...
Source: Internal Medicine - September 16, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

Incidentally Discovered Paget's Disease of Bone.
Authors: Takahashi K, Aozaki Y, Unno T, Ishizuka H PMID: 32921683 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - September 16, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

A Rare Case of L öffler "Pancarditis" Associated with Hypereosinophilic Syndrome.
A Rare Case of Löffler "Pancarditis" Associated with Hypereosinophilic Syndrome. Intern Med. 2020 Sep 12;: Authors: Yoshiji M, Matsumoto K, Fujita H, Miwa K, Tanaka H, Komatsu M, Hirata KI Abstract A 53-year-old woman was admitted to another hospital because of a 2-month history of repeated chest pain and breathlessness. Laboratory examinations demonstrated the presence of hypereosinophilia (absolute count of 6,500/μL). An endomyocardial biopsy confirmed eosinophilic infiltration with myocardial destruction. On cardiac magnetic resonance imaging, late gadolinium enhancement was clearl...
Source: Internal Medicine - September 16, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

Aortic Rupture due to Co-localization of Aortic Intimal Myofibroblastic Sarcoma and Urothelial Carcinoma: A Unique Case Report.
Authors: Ohashi Y, Yamamoto Y, Yamada A, Yamamoto K, Arai K, Namba F, Miyamoto N, Tomita M, Fukumoto T, Minamikawa T, Oka M Abstract We herein report a unique case of aortic rupture due to co-localization of aortic intimal myofibroblastic sarcoma (IMFS) and urothelial carcinoma (UC). A 76-year-old man who was being followed up after surgery for UC 5 years earlier developed aortic rupture and underwent emergency surgery. Intraoperatively, a tumorous mass on the luminal side of the aortic arch was found near the rupture. A histopathological analysis of the mass revealed aortic IMFS. Furthermore, co-localization of IM...
Source: Internal Medicine - September 16, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

Clinical Implications of Steroid Therapy for Crescentic Glomerulonephritis and Gemella morbillorum-associated Infective Endocarditis.
Authors: Kobayashi S, Kakeshita K, Imamura T, Fujioka H, Yamazaki H, Koike T, Kinugawa K Abstract A 54-year-old man was admitted to our institute with a diagnosis of infectious endocarditis with vegetation on the mitral valve and severe regurgitation due to Gemella morbillorum infection together with renal dysfunction, which was eventually diagnosed as infection-related pauci-immune necrotizing crescentic glomerulonephritis. Given the refractoriness to antibiotics, the persistent activity of nephritis, and repeated cerebral hemorrhaging, we prioritized steroid therapy over early surgical mitral valve replacement. F...
Source: Internal Medicine - September 16, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

Transcatheter Arterial Embolization Using Microspheres for Palliating Pain from Bone Metastasis in a Patient with Cholangiocellular Carcinoma.
Authors: Morita S, Sugawara S, Suda T, Prasetyo D, Hoshi T, Abe S, Yagi K, Terai S Abstract A 72-year-old man with intractable left shoulder pain due to bone metastasis from cholangiocellular carcinoma was admitted to our hospital. Computed tomography showed an osteoblastic metastatic lesion of the left scapula. Since the pain persisted even after the administration of opioids and external irradiation, microspheres were injected through a catheter; the catheter tip was placed at the arteries feeding the metastatic lesion. After the intervention, the shoulder pain was alleviated without any procedure-related complic...
Source: Internal Medicine - September 16, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

A Case of Celiac Disease Complicated by Rhabdomyolysis.
This report is only the tenth of its kind worldwide. PMID: 32921688 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - September 16, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

Acute Myocardial Infarction in a 17-year-old High-school Girl.
We report an unusual case of acute myocardial infarction in a high school girl. The patient was 17 years of age and had multiple coronary risk factors, including marked obesity with a body mass index (BMI) of 42.7 kg/m2, dyslipidemia and glucose intolerance. She had been an on and off smoker since she was 13 years of age. Due to the recent Westernization of the lifestyle, the prevalence of metabolic syndrome in the young generation has been increasing in Japan. Cardiovascular disease based on lifestyle-related diseases may become more common in young people. PMID: 32921689 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - September 16, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

A Cross-sectional Survey of Patients with Suspected Diabetic Peripheral Neuropathic Pain in Japan.
Conclusion In Japan, 22.8% of patients with diabetes have bilateral foot pain symptoms; some experience problems in their daily life without understanding the causes of their symptoms. This supports the importance of actions to increase awareness and minimize DPNP-associated impairment of daily life in patients with diabetes. PMID: 32921690 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - September 16, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

The Oldest Japanese Case of Combined Central and Peripheral Demyelination, which Developed Nine Years After the First Instance of Optic Neuritis.
Authors: Nomura E, Kawahara Y, Omote Y, Tadokoro K, Takemoto M, Hishikawa N, Yamashita T, Ogata H, Abe K Abstract Combined central and peripheral demyelination (CCPD) causes demyelination in both the central and peripheral nervous systems. Anti-neurofascin 155 antibody plays an important pathogenic role in CCPD, but evidence concerning an association between this antibody and CCPD remains inconclusive. Although there have been no reports of precedent optic neuritis developing into CCPD, we herein report a Japanese man in whom optic neuritis recurred four times over nine years and who developed CCPD without positive...
Source: Internal Medicine - September 16, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

A Case of Pulmonary Embolism and Splenic Infarction after Minocycline Infusion in a Patient with Polycythemia Vera.
Authors: Takeuchi M, Okada T, Iwato K, Kawamoto K, Ikegami Y, Nakamoto Y, Idei N, Ohashi N Abstract A 55-year-old man treated with polycythemia vera visited our hospital, complaining of left abdominal pain and dyspnea. He had received minocycline infusions three weeks earlier for mycoplasma pneumonia. Contrast-enhanced computed tomography revealed pulmonary embolism and splenic infarction. Ultrasonography of the vein in the forearm revealed a thrombus filling the distal brachial veins to the radial veins on both sides. His condition improved after anticoagulant therapy, and right and left shunts were detected on tr...
Source: Internal Medicine - September 16, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

A Case of Extremely Late Recurrence of Ovarian Carcinoma Diagnosed by an Endoscopic Ultrasound-guided Fine-needle Biopsy.
Authors: Chiba M, Goto T, Sato W, Shibuya T, Takahashi K, Minami S, Matsuzawa H, Sato Y, Iijima K Abstract We herein report a case of recurrence of epithelial ovarian carcinoma 41 years after the primary surgery that was diagnosed by an endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB). The differential diagnosis based on the imaging findings was difficult. We performed an EUS-FNB and compared the EUS-FNB specimen to the surgical specimen that had been resected in the primary surgery for ovarian carcinoma 41 years earlier, including immunohistochemical staining. Finally, we made a definitive diagnosis of ex...
Source: Internal Medicine - September 16, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

Treatment of Young Women with Acute Myocardial Infarction.
Authors: Mizutani Y, Ishikawa T, Nakahara S, Taguchi I PMID: 32921694 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - September 16, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

A Case of Graves' Disease after Adrenalectomy for Cushing's Syndrome.
Authors: Hiromatsu Y, Eguchi H, Nakamura Y, Mukohara K Abstract A 44-year-old woman presented with a 3-month history of back pain, gait disturbance, and insomnia. She had moon face and central obesity but no goiter. Cushing's syndrome due to left adrenal adenoma was diagnosed. She also had low triiodothyronine syndrome and central hypothyroidism. Treatment involved adrenalectomy followed by 30 mg/day of hydrocortisone. Inappropriate secretion of thyroid-stimulating hormone occurred postoperatively. She developed Graves' disease nine months postoperatively and was treated with methimazole. Excess glucocorticoids fol...
Source: Internal Medicine - September 10, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

A Case of Spastic Paraplegia with Paget's Disease of Bone due to a VCP Gene Mutation.
Authors: Nakamura T, Kawarabayashi T, Koh K, Takiyama Y, Ikeda Y, Shoji M Abstract Hereditary spastic paraplegia (HSP) is a neurodegenerative disorder clinically characterized by slowly progressing spastic paraparesis. We herein report a 50-year-old Japanese woman who presented with slowly progressing spastic paraplegia and a history of Paget's disease of bone (PBD). Genetic testing revealed a mutation of the VCP gene (p.Arg155Cys; c.436C>T). This mutation has not been reported to cause HSP with PBD. PMID: 32893227 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - September 10, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

Early Detection of High-grade Biliary Intraepithelial Neoplasia (BilIN-3) in the Cystic Duct Visualized by SpyGlass DS Cholangioscopy.
Authors: Miyabe K, Notohara K, Asano G, Kato A, Jinno N, Natsume M, Hori Y, Yoshida M, Naitoh I, Tsuboi K, Matsuo Y, Ohara H, Hayashi K, Kataoka H Abstract An 84-year-old man was admitted with epigastralgia. Computed tomography showed contrast-enhanced wall thickness in the cystic duct. An endoscopic examination revealed short irregular stricture in the cystic duct, and per-oral cholangioscopy revealed a reddish papillary tumor at the stricture site. Surgical resection revealed high-grade biliary intraepithelial neoplasia (BilIN) at the stricture site of the cystic duct. To our knowledge, this is the first case of ...
Source: Internal Medicine - September 10, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

Enlargement of Intrathoracic Goiter with Unilateral Phrenic Nerve Paralysis Leading to Cardiopulmonary Arrest.
Authors: Shioya N, Inoue N, Kawashima N, Tsukamoto Y, Nakayama M, Hazama K, Shichinohe Y, Suzuki H, Honma N Abstract As an intrathoracic goiter expands, it causes airway stenosis and phrenic nerve paralysis, and slight respiratory stimuli can trigger sudden life-threatening hypoventilation. A 78-year-old obese woman with a large intrathoracic goiter was found unconscious with agonal breathing in her room early in the morning. Cardiopulmonary resuscitation restored spontaneous circulation. She underwent surgical removal of the goiter; however, she required long-term mechanical ventilation because of atelectasis due ...
Source: Internal Medicine - September 10, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

Intratumor Abscess in a Posttraumatic Hepatic Inflammatory Pseudotumor Spreading Out of the Liver.
Authors: Hayashi M, Fujita M, Abe K, Takahashi A, Muto M, Ishigame T, Okada R, Marubashi S, Ohira H Abstract A 45-year-old woman with abdominal pain after minor trauma was referred to our hospital. Computed tomography (CT) showed a hypovascular tumor in the left liver lobe. A tumor biopsy revealed granuloma, although no findings indicated malignancy or infection. A follow-up imaging study showed spread of the hepatic tumor. Her abdominal pain worsened after a second minor trauma. CT revealed an intratumor abscess, and pus overflowed from the patient's umbilicus. The abscess was improved by antibiotics and drainage ...
Source: Internal Medicine - September 10, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

Coronavirus Disease 2019 Complicated by Multiple Simultaneous Intracerebral Hemorrhages.
Authors: Motoie R, Akai M, Kitahara T, Imamura H, Tanabe T, Sarazawa K, Takano S, Toda H, Komatsu K Abstract The relationship between coronavirus disease 2019 (COVID-19) and intracerebral hemorrhage remains unclear. We herein report a case of severe COVID-19 pneumonia complicated by multiple simultaneous intracerebral hemorrhages (MSICH). The patient died eight days after the episode of MSICH. No apparent coagulopathy was observed; however, extracorporeal membrane oxygenation and anticoagulation might have caused the occurrence of MSICH. Laboratory findings showed hypercoagulability, suggesting that thrombotic etio...
Source: Internal Medicine - September 10, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

Comment: "A Case of Subacute Combined Degeneration of the Spinal Cord Caused by Autoimmune Gastritis".
Comment: "A Case of Subacute Combined Degeneration of the Spinal Cord Caused by Autoimmune Gastritis". Intern Med. 2020 Sep 05;: Authors: Fustes OJH, Rodriguez CA PMID: 32893232 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - September 10, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

Pyuria without Casts and Bilateral Kidney Enlargement are Probable Hallmarks of Severe Acute Kidney Injury Induced by Acute Pyelonephritis - A Case Report and Literature Review.
Authors: Odajima K, Togashi R, Nemoto Y, Hayama Y, Asakawa S, Nagura M, Arai S, Yamazaki O, Tamura Y, Mochizuki M, Ohashi R, Shibata S, Fujigaki Y Abstract The patient was a 38-year-old man who had experienced nausea and fever for a few days and presented with back pain, oliguria, and pyuria, suggesting acute pyelonephritis (APN). He showed acute kidney injury (AKI) with bilateral kidney enlargement and was using nonsteroidal anti-inflammatory drugs (NSAIDs). AKI-induced by APN was confirmed by kidney biopsy. The AKI was successfully treated with antibiotic therapy. A search of the relevant literature for reports o...
Source: Internal Medicine - September 10, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

Reply to "Subacute Combined Degeneration of the Spinal Cord Caused by Autoimmune Gastritis".
Reply to "Subacute Combined Degeneration of the Spinal Cord Caused by Autoimmune Gastritis". Intern Med. 2020 Sep 05;: Authors: Ota K, Tsukahara A, Higuchi K PMID: 32893234 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - September 10, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

Exploratory Research on the Relationship between Human Gut Microbiota and Portal Hypertension.
Conclusion In the present study, we provided information on the characteristics of the gut microbiota of portal hypertension patients with esophago-gastric varices due to liver cirrhosis. In the future, we aim to develop probiotic treatments following further analyses that include the species level, such as the intestinal flora analysis method and next-generation sequencers. PMID: 32879200 [PubMed - in process] (Source: Internal Medicine)
Source: Internal Medicine - September 4, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

Authors' Reply: How to Increase the Rate of Optimal Medical Therapy following Acute Myocardial Infarction.
Authors: Haraguchi Y, Sakakura K, Fujita H PMID: 32879201 [PubMed - in process] (Source: Internal Medicine)
Source: Internal Medicine - September 4, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

Endoscopy and Barrett's Esophagus: Current Perspectives in the US and Japan.
Authors: Oda M, Kalloo A, Mizukami K, Murakami K, Sawa A Abstract Barrett's esophagus (BE) is a precancerous disease that can lead to esophageal adenocarcinoma (EAC). Recently, the incidence of EAC arising from BE has been increasing, and EAC has now become a threat in many countries. However, there are many gaps among the various countries in terms of definitions and concepts and these gaps prevent discussing BE on the same footing. In order to eradicate BE, it is a global necessity to fill in these remaining gaps. We focused on the gaps and reviewed recent evidence and trends as well as the background of gaps bet...
Source: Internal Medicine - September 1, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

Two Cases of Primary Rhinovirus Pneumonia with Multiple Pulmonary Nodules.
Authors: Morimoto Y, Ishiguro T, Kasuga K, Takano K, Ozawa R, Isono T, Akiyama Y, Kobayashi Y, Kobayashi Y, Shimizu Y, Takayanagi N Abstract Two patients, a 60-year-old man and 43-year-old woman, presented to our hospital with symptoms of respiratory tract infection. These patients showed imaging findings of multiple small nodules, ground-glass opacities, and consolidations. In case 1, although antibiotics were started, bilateral shadows spread widely, which made us suspect interstitial pneumonia. The condition improved after steroid administration, and there has been no recurrence since completing this treatment. ...
Source: Internal Medicine - September 1, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

Using Polyethylene Glycol 3350 Plus Electrolytes in Constipated Hemodialysis Patients: A Case Series.
In conclusion, polyethylene glycol can be a useful tool for managing constipated hemodialysis patients. PMID: 32863362 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - September 1, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

Intermittent Purpura Development Associated with Leukocytoclastic Vasculitis Induced by Infliximab for Crohn's Disease: A Case Report.
Authors: Kishimoto K, Kawashima K, Fukunaga M, Kotani S, Sonoyama H, Oka A, Mishima Y, Oshima N, Ishimura N, Ishikawa N, Maruyama R, Ishihara S Abstract Anti-TNFα agents, widely used for the treatment of Crohn's disease (CD), can sometimes induce skin-associated adverse events, which mainly include psoriasis-like eruptions, eczema, and cutaneous infections. In contrast, purpura caused by vasculitis is rarely seen. We herein report a unique case of leukocytoclastic vasculitis induced by infliximab administered for CD in which intermittent purpura development was noted. Fluorescent immunostaining showed no immu...
Source: Internal Medicine - September 1, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

Successful Recovery from COVID-19-associated Acute Respiratory Failure with Polymyxin B-immobilized Fiber Column-direct Hemoperfusion.
Authors: Kusaba Y, Izumi S, Takasaki J, Suzuki M, Katagiri D, Katsuno T, Matsumoto S, Sakamoto K, Hashimoto M, Ohmagari N, Katano H, Suzuki T, Hojo M, Sugiyama H Abstract An 83-year-old man was hospitalized for coronavirus disease 2019 (COVID-19) after a 10-day history of a persistent fever. Chest computed tomography showed extensive non-segmental ground glass opacity. Despite the initiation of lopinavir and ritonavir, respiratory failure progressed. Two days of polymyxin B-immobilized fiber column-direct hemoperfusion (PMX-DHP) with adjunctive corticosteroid prevented his respiratory condition from worsening. For ...
Source: Internal Medicine - September 1, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

Multiple Malignant Lymphomas of the Bile Duct Developing after Spontaneous Regression of an Autoimmune Pancreatitis-like Mass.
Authors: Ohtsubo K, Yamashita K, Yanagimura N, Suzuki C, Tanimoto A, Nishiyama A, Takeuchi S, Iwaki N, Kawano M, Izumozaki A, Inoue D, Gabata T, Ikeda H, Watanabe M, Yano S Abstract We herein report a 67-year-old woman with malignant lymphomas of the bile duct that developed after regression of a pancreatic head mass. Computed tomography suggested the mass was pancreatic head cancer. Endoscopic ultrasonography showed a low-echoic mass with hyperechoic strands resembling autoimmune pancreatitis. Her serum IgG4 concentration was elevated to 674 mg/dL. After the pancreatic head mass spontaneously diminished, three mas...
Source: Internal Medicine - September 1, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

A Case of the Development of Foveolar-type Gastric Adenocarcinoma during Maintenance Therapy of Vonoprazan for Reflux Esophagitis.
Authors: Saito M, Koike T, Abe Y, Nakagawa K, Kanno T, Jin X, Hatta W, Uno K, Asano N, Imatani A, Fujishima F, Masamune A Abstract We herein report the first case of foveolar-type gastric adenocarcinoma that developed after the initiation of vonoprazan (VPZ). A 51-year-old man had heartburn at the first visit and reflux esophagitis endoscopically, so he started taking VPZ. An approximately 5-mm-sized reddish polyp with a raspberry-like morphology was detected at the anterior wall of the upper body of the stomach 156 weeks after starting maintenance therapy with VPZ 10 mg/day. It was diagnosed as foveolar-type gastr...
Source: Internal Medicine - September 1, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

Sensory Nerve Conduction Study with Inching Test in Palmar Digital Neuropathy.
Authors: Ueno T, Baba M, Arai A, Suzuki C, Tomiyama M Abstract Mild palmar digital neuropathy may be underestimated because selective nerve conduction studies (NCS) of the palmar digital nerve are challenging. We herein report two cases of palmar digital neuropathy. We performed sensory NCS in each finger using the standard approach. Both cases showed a decrease in the amplitude of sensory nerve action potential (SNAP) in the localized finger. Furthermore, the sensory nerve inching test identified the lesion site. When performing NCS in patients with finger sensory impairment, we recommend recording the SNAP in eac...
Source: Internal Medicine - September 1, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

Massive Ascites Caused by Primary Diffuse Large B-cell Lymphoma of the Jejunum: A Case of a Rare Initial Symptom.
Authors: Ota K, Nishida S, Akutagawa H, Imai Y, Tani K, Shinohara Y, Iwatsubo T, Shimpei K, Kojima Y, Takeuchi T, Higuchi K Abstract A 74-year-old man presented with abdominal swelling. Computed tomography revealed massive ascites and localized thickening of the small intestinal wall. Enteroscopy showed ulcerative lesions along the circumference of the jejunum. Histological examination showed dense proliferation of large lymphoid atypical cells, and immunohistochemistry showed CD20 and CD10 positivity, CD3 negativity, and Ki67 labeling index>80%. Cytology of the ascitic fluid revealed large lymphoid cells. These...
Source: Internal Medicine - September 1, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

Impeding Subclavian Subcutaneous Swelling.
Authors: Hayashida A, Kawamoto T, Hirohata A, Yoshida K PMID: 32863369 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - September 1, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

Esophageal Dysphagia Induced by Kommerell's Diverticulum.
Authors: Okagawa Y, Sumiyoshi T, Sakurada A, Kondo H PMID: 32863370 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - September 1, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

Membranous Nephropathy with Proteinase 3-ANCA-associated Vasculitis Successfully Treated with Rituximab.
Authors: Yoshida S, Hanai S, Nakagomi D, Kobayashi K, Takahashi K, Furuya F Abstract Membranous nephropathy (MN) with anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis (ANCA-GN) is seen infrequently. Previous reports of patients with ANCA-GN with MN showed that the most frequent ANCA subtype was myeloperoxidase-ANCA. We herein present a 73-year-old woman with scleritis, hematuria, proteinuria, and positive serum proteinase 3 (PR3)-ANCA. She underwent a renal biopsy and was diagnosed with MN and ANCA-GN. Immunofluorescence staining for PR3 colocalized with IgG along the glomerular basement me...
Source: Internal Medicine - August 25, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

Progression of Central-peripheral Band and Traction Bronchiectasis Clusters Leading to Chronic Respiratory Failure in a Patient with Fibrotic Pulmonary Sarcoidosis.
Authors: Sawahata M, Shijubo N, Johkoh T, Kawanobe T, Fujiki Y, Bando M, Hagiwara K, Takemura T, Konno S, Yamaguchi T Abstract We herein report a rare case of pulmonary sarcoidosis leading to chronic respiratory failure with restrictive ventilatory impairment during a 53-year-long observation period. Nine years after the histological diagnosis of stage I sarcoidosis on chest X-ray in a woman in her 20s, she developed bilateral reticular and granular opacities on chest computed tomography and was started on prednisone for 18 years. Seven years after prednisone withdrawal, these persisting opacities around the bronch...
Source: Internal Medicine - August 25, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

A Case of Multiple Cerebral Infarction Associated with Cerebral Vasculitis in a Patient with Ulcerative Colitis.
Authors: Yasuda T, Takagi T, Hasegawa D, Hirose R, Inoue K, Dohi O, Yoshida N, Kamada K, Uchiyama K, Ishikawa T, Konishi H, Naito Y, Itoh Y Abstract A 40-year-old man was admitted to the hospital due to both a worsening of symptoms associated with ulcerative colitis (UC), which had been diagnosed 3 years previously, and limb paralysis. Colonoscopy revealed severe pancolitis-type UC. He was diagnosed with cerebral vasculitis with multiple white matter infarctions associated with the disease activity of UC by contrast-enhanced head magnetic resonance imaging. Mesalazine at 4,000 mg/day and prednisolone at 60 mg/day w...
Source: Internal Medicine - August 25, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

Anti-MuSK positive myasthenia gravis with anti-Lrp4 and anti-titin antibodies.
Authors: Yamashita R, Shimizu M, Baba K, Beck G, Kinoshita M, Okuno T, Higuchi O, Mochizuki H Abstract In addition to muscle nicotinic acetylcholine receptor (AChR) and muscle-specific kinase (MuSK), low-density lipoprotein receptor (Lrp4) has recently been discovered to be a novel target antigen among patients with seronegative myasthenia gravis (MG). We herein report the findings of a 62-year-old patient who showed positivity for anti-MuSK, anti-Lrp4, and anti-titin antibodies. The patient developed MG crisis following a 10-year history of intermittent double vision with ptosis, and a 7-year history of dropped he...
Source: Internal Medicine - August 25, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

A Case of Mycophenolate Mofetil-induced Diffuse Large B-cell Lymphoma in Which a Solitary Lung Nodule Remitted Spontaneously.
Authors: Kobe H, Ito A, Hayata H, Nishimura K, Ueda Y, Ishida T Abstract A 76-year-old woman with dermatomyositis was being treated with prednisolone, tacrolimus, and mycophenolate mofetil. There was a solitary lung nodule in the right middle lobe on chest computed tomography at a routine follow-up examination. A transbronchial lung biopsy was performed, and the histopathologic findings indicated diffuse large B-cell lymphoma. An immunodeficiency-associated lymphoproliferative disorder was suspected, and mycophenolate mofetil was stopped without adding any other therapy. Nine months later, the pulmonary nodule had ...
Source: Internal Medicine - August 25, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

A Case of Idiopathic Pulmonary Hemosiderosis Associated with Emphysematous Change in an Adult Who Underwent Lung Transplantation.
Authors: Gocho K, Sato K, Imasaka K, Hamanaka N, Takahashi M, Shimizu K, Takemura T Abstract Idiopathic pulmonary hemosiderosis is characterized by repeated alveolar hemorrhaging. We herein report a 52-year-old Japanese woman who had shortness of breath, diffuse small nodules, thin-walled cysts, and bronchiolectasis. A surgical lung biopsy revealed peribronchial hemosiderosis, centrilobular emphysema, and fragile elastic fibers of the alveolar septa and small vessels. She ultimately underwent living-donor lung transplantation five years after the first visit. PMID: 32830179 [PubMed - as supplied by publisher] (...
Source: Internal Medicine - August 25, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

Treatment of Refractory Hypertension with Timely Angioplasty in Total Renal Artery Occlusion with Atrophic Kidney.
Authors: Sasaki Y, Mishima E, Kikuchi K, Toyohara T, Suzuki T, Ota H, Seiji K, Miyazaki M, Harigae H, Ito S, Takase K, Abe T Abstract Angioplasty for cases of chronic total occlusion of renal artery with/without atrophic kidney is generally not recommended. We here report a 57-year-old man who presented with renin-mediated refractory hypertension caused by occlusion of a unilateral renal artery leading to kidney atrophy (length: 69 mm). Angioplasty favorably achieved blood pressure control with normalized renin secretion and enlargement of the atrophic kidney to 85 mm. Timely angioplasty can be beneficial in select...
Source: Internal Medicine - August 25, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

A Case of Gastric MiNEN Arising from the Heterotopic Gastric Glands.
Authors: Tanaka Y, Tokubayashi Y, Fujii S, Kusaka T, Shibuya S, Kokuryu H Abstract An 80-year-old woman presented with a 30-mm protruding lesion-like submucosal tumor with a central depression located at the anterior wall of the upper gastric body. The depressed area had a well-demarcated margin, while the other area was covered by a non-neoplastic mucosa. A biopsy specimen revealed neuroendocrine carcinoma. Endoscopic ultrasonography revealed a heterogeneous mass with a clearly distinguished border in the submucosal layer. The mass had two distinct areas adjacent to each other. In addition, a hypoechoic zone was o...
Source: Internal Medicine - August 25, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

Intestinal Manifestations of Generalized Lymphatic Anomaly.
Authors: Okamoto T, Fukuda K PMID: 32830182 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - August 25, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

Dramatic Recovery From Cardiovascular Collapse: Paclitaxel as an Urgent Treatment for Primary Cardiac Angiosarcoma.
Authors: Suzuki T, Yamamoto Y, Sakamoto N, Suzuki H, Tajiri K, Ishizu T, Fujisawa Y, Noguchi M, Ieda M, Hiramatsu Y, Sekine I Abstract We herein report three patients with cardiac angiosarcoma who were directly admitted to the intensive-care unit for hemodynamic instability with circulatory collapse. Using a multidisciplinary cardio-oncologic approach, we diagnosed their condition as angiosarcoma by an invasive biopsy and urgently started weekly paclitaxel administration despite their poor performance status. Their vital signs were soon stabilized, leading to the patients' discharge from the hospital. Although no t...
Source: Internal Medicine - August 25, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

Duodenal Metastasis from a Pancreatic Neuroendocrine Neoplasm.
Authors: Koiwai A, Hirota M, Satoh K PMID: 32830184 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - August 25, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

A Case of Bradycardia Shock Caused by the Combined Use of Carteolol Eye Drops and Verapamil in an Elderly Patient with Atrial Fibrillation and Chronic Kidney Disease.
Authors: Arai R, Fukamachi D, Monden M, Akutsu N, Murata N, Okumura Y Abstract Ophthalmic carteolol is often used to treat glaucoma. Elderly patients with atrial fibrillation (AF) and chronic kidney disease (CKD) are common among the super-elderly in Japan. Because these patients are exposed to polypharmacy, they are at a high-risk of adverse drug interactions. We herein report an elderly patient with CKD who suffered bradycardia shock after the combined use of carteolol eye drops and verapamil for glaucoma and paroxysmal AF. This case highlights the fact that eye drops have a similar systemic effect to oral drugs,...
Source: Internal Medicine - August 25, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research