Late-onset Myasthenia Gravis Accompanied by Amyotrophic Lateral Sclerosis with Antibodies against the Acetylcholine Receptor and Low-density Lipoprotein Receptor-related Protein 4.
Authors: Ohnari K, Okada K, Higuchi O, Matsuo H, Adachi H Abstract An 82-year-old woman developed neck weakness and dysarthria with antibodies against acetylcholine receptor (AChR) and low-density lipoprotein receptor-related protein 4 (LRP4). Myasthenia gravis (MG) was diagnosed by edrophonium and repetitive nerve stimulation tests. Her symptoms resolved completely by immunotherapy. One year later, she presented with muscle weakness and bulbar palsy accompanied by atrophy and fasciculation. Her tendon reflexes were brisk, and Babinski's sign was positive. She was diagnosed with probable amyotrophic lateral scleros...
Source: Internal Medicine - October 17, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Spontaneous Isolated Superior Mesenteric Artery Dissection Requiring Emergent Surgery.
Authors: Tanaka Y, Tada H, Takeda Y, Iino K, Hayashi K, Takemura H, Yamagishi M, Kawashiri MA Abstract A 52-year-old man with a history of hypertension was referred to our hospital due to persistent abdominal pain. Abdominal palpation revealed remarkable rigidity and rebound tenderness all over the abdomen. Enhanced computed tomography demonstrated the superior mesenteric artery (SMA) dissection with a complete obstruction at the middle part of the SMA. Intraoperative findings showed significant necrosis in the most small intestine and surgical resection was performed. Emergent operation is warranted once abdominal...
Source: Internal Medicine - September 20, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

A Low Early High-density Lipoprotein Cholesterol Level is an Independent Predictor of In-hospital Death in Patients with Acute Coronary Syndrome.
Conclusion ACS patients with low early HDL-C levels had higher in-hospital mortalities than those who did not have low early HDL-C levels. In addition to the already well-known determinants, low early HDL-C should also be considered as an independent predictor of in-hospital mortality in ACS patients who present to a cardiac care unit. PMID: 30210100 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - September 15, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Differences in Adherence Barriers to Inhaled Medicines between Japanese Patients with Chronic Obstructive Pulmonary Disease and Asthma Evaluated using the "Adherence Starts with Knowledge 20" (ASK-20) Questionnaire.
Differences in Adherence Barriers to Inhaled Medicines between Japanese Patients with Chronic Obstructive Pulmonary Disease and Asthma Evaluated using the "Adherence Starts with Knowledge 20" (ASK-20) Questionnaire. Intern Med. 2018 Sep 12;: Authors: Toyama T, Kawayama T, Kinoshita T, Imamura Y, Yoshida M, Takahashi K, Fujii K, Higashimoto I, Hoshino T Abstract Objective This multicenter, cross-sectional, non-interventional trial aimed to investigate adherence barriers to inhaled medicines when compared with oral medicines in Japanese patients with chronic obstructive pulmonary disease (COPD)...
Source: Internal Medicine - September 15, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Aortic Mural Thrombus in the Non-Atherosclerotic Aorta of Patients with Multiple Hypercoagulable Factors.
Authors: Yagyu T, Naito M, Kumada M, Nakagawa T Abstract An aortic mural thrombus (AMT) on a non-atherosclerotic wall is a rare but important cause of arterial thromboembolism. We herein report two cases of AMT in the thoracic aorta. Both showed multiple hypercoagulable factors (case 1: protein S deficiency and positive finding of anti-cardiolipin antibody; case 2: protein C deficiency, gastric cancer, and cisplatin-based chemotherapy) and were successfully treated with anticoagulation. Hypercoagulable states, including malignancy, can influence the formation of AMT; therefore, the accurate assessment of a hypercoa...
Source: Internal Medicine - September 15, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

The Effectiveness of Cost Reduction with Charge Displays on Test Ordering under the Health Insurance System in Japan: A Study Using Paper-based Simulated Cases for Residents and Clinical Fellows.
Conclusion Displaying the charges when ordering tests in paper-based simulated cases resulted in cost reduction. The adoption of this intervention may reduce health insurance costs under the health insurance system in Japan, which has features such as universal health coverage and universal access to care. PMID: 30210103 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - September 15, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Severe Community-acquired Pneumonia Caused by Acinetobacter baumannii Successfully Treated with the Initial Administration of Meropenem Based on the Sputum Gram Staining Findings: A Case Report.
Authors: Iwasawa Y, Hosokawa N, Harada M, Hayano S, Shimizu A, Suzuki D, Nakashima K, Yaegashi M Abstract A 62-year-old man with diabetes mellitus and a two-day history of fever and dyspnea presented at our hospital. He was diagnosed with community-acquired pneumonia (CAP), septic shock, and respiratory failure. Sputum Gram staining revealed Gram-negative coccobacilli. Based on the Gram staining findings and history, Acinetobacter baumannii was considered as one of the causative organisms of his CAP. Consequently, he was successfully treated with the initial administration of meropenem. We suggest that A. baumannii...
Source: Internal Medicine - September 15, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

A Case of Bilateral Adrenocortical Adenomas along with Virilization and Cushing's Syndrome.
Authors: Kobayashi T, Imachi H, Sato S, Ibata T, Fukunaga K, Yoshimoto T, Kikuchi F, Yonezaki K, Yamaji N, Lyu J, Dong T, Nagata H, Kadota K, Kushida Y, Haba R, Murao K Abstract We herein present the case of a 27-year-old woman with clinical and biochemical features of virilism. Imaging studies revealed the presence of a bilateral adrenal tumor. Although the secretion of androgens was remarkable, the autonomous production of cortisol was also evident because of a loss of circadian rhythm and the absence of cortisol suppression by dexamethasone. The surgical excision of both adrenal tumors was performed, and the his...
Source: Internal Medicine - September 15, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Acute Unilateral Isolated Oculomotor Nerve Palsy in an Adult Patient with Influenza A.
Authors: Senda J, Araki K, Tachi Y, Watanabe H, Kagawashira Y, Ito M, Atsuta N, Katsuno M, Watanabe H, Sobue G Abstract An otherwise healthy 44-year-old woman exhibited isolated unilateral oculomotor nerve palsy accompanied by an influenza A infection. An intra-orbital MRI scan revealed that her right third intracranial nerve was enlarged and enhanced. She recovered completely during the first month after treatment with oseltamivir phosphate. Although intracranial nerve disorders that result from influenza infections are most frequently reported in children, it is noteworthy that influenza can also cause focal intr...
Source: Internal Medicine - September 15, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

A Rare Case of Klinefelter Syndrome Accompanied by Spastic Paraplegia and Peripheral Neuropathy.
Authors: Sasaki R, Ohta Y, Takahashi Y, Tsunoda K, Tadokoro K, Sato K, Shang J, Takemoto M, Hishikawa N, Yamashita T, Abe K Abstract Klinefelter syndrome is a chromosomal disorder with a typical karyotype of 47, XXY, accompanied by various neurological symptoms. We herein report the first case of Klinefelter syndrome with a rare mosaic form of 47, XXY and 48, XXXY, combined with both spastic paraplegia and peripheral motor neuropathy. This case showed spasticity and hyperreflexia with pathological reflexes and ankle clonus as well as muscle weakness in all extremities. A motor nerve conduction study and the magneti...
Source: Internal Medicine - September 15, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Lipoprotein Lipase Deficiency Arising in Type V Dyslipidemia.
Authors: Tanaka S, Ueno T, Tsunemi A, Nakamura Y, Kobayashi H, Hatanaka Y, Haketa A, Fukuda N, Soma M, Abe M Abstract A 40-year-old Japanese man presented with child-onset hypertriglyceridemia recently complicated by diabetes mellitus. The patient's diabetes mellitus was maintained, but he had persistent insulin resistance. The patient also had persistent severe hypertriglyceridemia (1,224-4,104 mg/dL), despite the administration of bezafibrate and ezetimibe. Type V dyslipidemia was revealed by agarose gel electrophoresis and the refrigerator test, and a significantly reduced post-heparin lipoprotein lipase mass of...
Source: Internal Medicine - September 15, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

A Case of a Small Cell Lung Cancer Patient with Anti-transcriptional Intermediary Factor 1 γ Antibody Who Developed Dermatomyositis after Successful Chemoradiotherapy.
A Case of a Small Cell Lung Cancer Patient with Anti-transcriptional Intermediary Factor 1γ Antibody Who Developed Dermatomyositis after Successful Chemoradiotherapy. Intern Med. 2018 Sep 12;: Authors: Aritomi T, Kido T, Nakano K, Satoh Y, Noguchi S, Jotatsu T, Hanaka T, Satoh M, Tanaka Y, Yatera K Abstract We herein report a 63-year-old woman with small-cell lung cancer (SCLC) who developed dermatomyositis (DM) after initial chemoradiotherapy despite tumor reduction. Serum anti-TIF1γ antibody was detected before the development of DM, and its levels increased over time. She died five month...
Source: Internal Medicine - September 15, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

A Case of Persistent Vegetative State after Diabetic Ketoacidosis Triggered by an Overdose of Psychotropic Agents.
Authors: Kawashita T, Nakajima M, H Kaszynski R, Shirokawa M, Nakano T, Ochiai K, Inoue Y, Goto H Abstract A 28-year-old man with type 1 diabetes mellitus was admitted for shock and coma due to diabetic ketoacidosis. Despite aggressive treatment and management of the patient's underlying clinical issues, the patient remained in a comatose state. Further investigations revealed an excess consumption of psychotropic agents; however, there was no evidence of an insulin overdose. Physicians should be aware that, in patients who are highly dependent upon insulin, an overdose of psychotropic agents can lead to hypoxic-is...
Source: Internal Medicine - September 15, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Support for Patients who have Difficulty Quitting Smoking: A Review.
Authors: Komiyama M, Takahashi Y, Tateno H, Mori M, Nagayoshi N, Yonehara H, Nakasa N, Haruki Y, Hasegawa K Abstract Smoking cessation plays a crucial role in reducing preventable morbidity and mortality. However, some smokers find smoking cessation difficult, despite receiving treatment. This includes heavy smokers with chronic obstructive pulmonary disease, smokers with a psychiatric disorder, and female and underage smokers. This review article describes smoking cessation approaches for patients who find it difficult to quit smoking. PMID: 30210111 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - September 15, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Endoscopic Submucosal Dissection for Gastric-phenotype Adenoma on the Surface of Gastric Gastrointestinal Stromal Tumor.
Authors: Yamamoto S, Nishimura N, Mizuno M, Shimodate Y, Doi A, Mouri H, Matsueda K, Yamamoto H Abstract We herein report a rare case of a gastric adenoma overlying a gastrointestinal stromal tumor (GIST) that was removed by endoscopic submucosal dissection (ESD). A 78-year-old woman was referred to our hospital. Esophagogastroduodenoscopy revealed an elevated lesion of 15 mm in diameter overlying a submucosal mass in the gastric cardia. ESD was performed for the epithelial neoplasm, and biopsy specimens were obtained directly from the exposed surface of the submucosal tumor. The epithelial tumor was a tubular aden...
Source: Internal Medicine - September 15, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Headache due to Spontaneous Spinal Cerebrospinal Fluid Leaks.
Authors: Fujiwara M, Moriyama E, Araki T PMID: 30210113 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - September 15, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

A Case of Intratumoral Hemorrhage of Liver Metastasis from a Rectal Neuroendocrine Tumor.
Authors: Hatanaka T, Naganuma A, Saito T, Hoshino T, Kakizaki S, Kumasaka T, Takamoto T, Makuuchi M Abstract A 56-year-old healthy woman was referred to our hospital for abdominal pain. Contrast-enhanced computed tomography (CT) showed a 14-cm-diameter liver tumor with intratumoral hemorrhage. We performed emergent transcatheter arterial embolization. She was referred to hepatic surgeon (M.M.) for resection. Preoperative colonoscopy showed an elevated lesion measuring 2 cm in diameter that was pathologically diagnosed as a rectal neuroendocrine tumor (NET). We performed low anterior resection of the rectum, followe...
Source: Internal Medicine - September 15, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Randomized Controlled Trial Comparing the Effects of Vonoprazan Plus Rebamipide and Esomeprazole Plus Rebamipide on Gastric Ulcer Healing Induced by Endoscopic Submucosal Dissection.
Conclusion Combination therapy consisting of vonoprazan plus rebamipide was not superior to that of esomeprazole plus rebamipide for post-ESD ulcer healing (UMIN000019516). PMID: 30210115 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - September 15, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Atypical Clinical Presentation of Crohn's Disease with Superior Mesenteric Vein Obstruction and Protein-losing Enteropathy.
Authors: Ito S, Higashiyama M, Horiuchi K, Mizoguchi A, Soga S, Tanemoto R, Nishii S, Terada H, Wada A, Sugihara N, Hanawa Y, Furuhashi H, Takajo T, Shirakabe K, Watanabe C, Komoto S, Tomita K, Nagao S, Shinozaki M, Nakagawa A, Kubota M, Miyagishima D, Gotoh N, Miura S, Ueno H, Hokari R Abstract We herein report a 44-year-old man suffering from systemic edema due to protein-losing enteropathy (PLE) with superior mesenteric vein (SMV) obstruction and development of collateral veins, which subsequently proved to be a chronic result of thrombosis and a complication of Crohn's disease (CD). PLE was supposedly induced b...
Source: Internal Medicine - September 15, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

A Rare Form of Intraductal Papillary Mucinous Carcinoma.
Authors: Yamada R, Nishikawa K, Tanaka K, Tsuboi J PMID: 30210117 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - September 15, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Mandibular Herpes Zoster.
Authors: Kosami K, Kenzaka T PMID: 30210118 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - September 15, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Fatal Chronic Active Epstein-Barr Virus Infection in a Rheumatoid Arthritis Patient Treated with Abatacept.
We report a case of fatal CAEBV T-cell type infection in an RA patient undergoing treatment with cytotoxic T-lymphocyte-associated antigen 4 immunoglobulin fusion protein (abatacept, ABT). CAEBV can rapidly worsen in RA patients receiving ABT. Thus, we should try to establish an early diagnosis in patients with CAEBV infection. PMID: 30210119 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - September 15, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Hereditary Hemorrhagic Telangiectasia with SMAD4 Mutations is Associated with Fatty Degeneration of the Left Ventricle, Coronary Artery Aneurysm, and Abdominal Aortic Aneurysm.
Authors: Inoguchi Y, Kaku B, Kitagawa N, Katsuda S Abstract A 52-year-old man with recurrent epistaxis and palpebral conjunctival telangiectasia visited our hospital for a follow-up checkup for gastrointestinal polyposis. At 48 years of age, he underwent Y-graft replacement for an abdominal aortic aneurysm. Arteriovenous malformation (AVM) was detected in his lungs, and a genetic test revealed an SMAD4 mutation. Eventually, he was diagnosed with juvenile polyposis-hereditary hemorrhagic telangiectasia (JP-HHT) syndrome. In addition, fatty degeneration of the left ventricle (LV) and a coronary aneurysm were detected...
Source: Internal Medicine - September 15, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Auricle Pain Due to Tophi.
Authors: Nakano Y, Otsuka F PMID: 30210121 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - September 15, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Association between Functional Dyspepsia and Gastric Depressive Erosions in Japanese Subjects.
Conclusion Gastric depressive erosions may be associated with dyspepsia. PMID: 30210122 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - September 15, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

An analysis of the biological disease-modifying antirheumatic drug-free condition of adalimumab-treated rheumatoid arthritis patients.
Conclusions A sustainable Bio-free condition in a real clinical setting can be achieved and may be a suitable way of reducing medical costs. The dose of MTX and the additional administration of csDMARDs is therefore thought to be important for ensuring a good outcome in these patients. PMID: 30210123 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - September 15, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Transient Diffusion-weighted Imaging Hyperintensity of the Cerebellar Cortex in Paraneoplastic Cerebellar Degeneration.
Authors: Hashimoto Y, Komatsu K, Nakagawa T, Matsumoto S PMID: 30210124 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - September 15, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

A Case of Nutcracker Syndrome with the Superimposition of Thin Basement Membrane Syndrome.
Authors: Hirakawa Y, Miura R, Sasaki Y, Yoshida Y, Mimura I, Katsura M, Shintani-Domoto Y, Ogawa M, Hayashi A, Nangaku M Abstract A 21-year-old woman was referred to our hospital because of proteinuria and hematuria. She had occasional flank pain. A renal biopsy was performed and revealed a thin basement membrane. Therefore, she was diagnosed with thin basement membrane disease. However, the frequency of her flank pain increased. Since her left kidney was slightly larger than the right, nutcracker syndrome (NCS) was suspected. Renal vein ultrasonography and venography were performed, and NCS was confirmed. Her hema...
Source: Internal Medicine - September 15, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Pulmonary Multiloculated 'Lotus Torus-like' Sarcoidosis Mimicking Lung Adenocarcinoma.
Authors: Kanaji N, Nakashima N, Inoue T, Ibuki E, Murota M, Kadowaki N Abstract A 34-year-old Japanese woman exhibited a 35×25-mm solitary multiloculated mass shadow in the left lower lobe mimicking lung adenocarcinoma. On computed tomography, the mass resembled a lotus torus. A transbronchial lung biopsy and mediastinal lymph node biopsy led to the diagnosis of sarcoidosis. This lotus torus-like mass regressed spontaneously. This is the second reported case of pulmonary cavitary sarcoidosis with a 'lotus torus-like' appearance. We propose several findings regarding the lotus torus-like appearance by comparin...
Source: Internal Medicine - September 15, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Yellow Nail Syndrome Patients with Diffuse Panbronchiolitis-like pulmonary manifestation: Two case reports.
Authors: Imai R, Nakatani R, Nakaoka H, Tomishima Y, Jinta T, Chonabayashi N, Tamura T Abstract Yellow nail syndrome (YNS) is a rare clinical syndrome characterized by a triad of yellow thick nail, lymphedema and respiratory diseases. We experienced 2 cases of YNS with diffuse panbronchiolitis (DPB)-like pulmonary manifestation. Since YNS might be hidden to those who have been diagnosed with DPB, physicians should be alert to recognize nail signs of YNS in case of DPB refractory to macrolide therapy. We hereby review previous case reports of YNS and discuss its pulmonary manifestations. PMID: 30210127 [PubMed -...
Source: Internal Medicine - September 15, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Foix-Chavany-Marie Syndrome Induced by a Unilateral Brain Abscess.
Authors: Shoji R, Kono Y, Furuhashi H, Nakano M, Torisu Y Abstract Foix-Chavany-Marie syndrome (FCMS) is a rare cortical type of pseudobulbar palsy characterized by the loss of voluntary control of the facial, pharyngeal, lingual, and masticatory muscles with preserved reflexive and autonomic functions. FCMS is generally associated with cerebrovascular diseases affecting the bilateral opercular regions. We herein report the clinical features of an 84-year-old right-handed Japanese man with FCMS due to a unilateral brain abscess. The patient' s symptoms were resolved after treating the brain abscess. The present cli...
Source: Internal Medicine - September 15, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Development of Pulmonary Arterial Hypertension in a Patient Treated with Qing-Dai (Chinese Herbal Medicine).
Authors: Misumi K, Ogo T, Ueda J, Tsuji A, Fukui S, Konagai N, Asano R, Yasuda S Abstract Pulmonary arterial hypertension (PAH) is a rare, devastating disease, characterized by elevated pulmonary arterial pressure due to pulmonary microvascular obstruction, which can result in heart failure and death. PAH can be associated with exposure to certain drugs or toxins. We herein report a case in which PAH developed in a patient with refractory ulcerative colitis (UC) during treatment with "Qing-Dai," a Chinese herbal medicine. The patient's PAH improved after the discontinuation of Qing-Dai. PMID: 30210129...
Source: Internal Medicine - September 15, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

The Hypercholesterolemia Paradox in Percutaneous Coronary Intervention: An Analysis of a Multicenter PCI Registry.
Conclusion HC was associated with better outcomes in patients who underwent EES implantation, even after baseline adjustment. PMID: 30210130 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - September 15, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Hepatitis B Virus Reactivation in a Patient with Nonalcoholic Steatohepatitis 41 Months after Rituximab-containing Chemotherapy: A Case Report.
Authors: Hayashi M, Abe K, Fujita M, Okai K, Takahashi A, Ohira H Abstract Hepatitis B virus (HBV) reactivation occasionally occurs long after immunosuppressive therapy. The characteristics of late HBV reactivation remain unclear. We herein present a case of HBV reactivation in a patient with nonalcoholic steatohepatitis (NASH) more than 3 years after rituximab-containing chemotherapy for diffuse large B-cell lymphoma. Increased transaminase levels, which were induced by NASH, were observed after chemotherapy and were alleviated with statin treatment. HBV reactivation was identified incidentally. The patient develo...
Source: Internal Medicine - September 15, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Disseminated Nocardiosis Initially Manifesting as Visual Field Defects.
Authors: Okimoto T, Tsubata Y, Nakao M, Isobe T PMID: 30210132 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - September 15, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Ureteropelvic Junction Obstruction Underlying Pyelonephritis in an Adult.
Authors: Watanabe T, Yokoe M, Noguchi Y PMID: 30210133 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - September 15, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Gemcitabine, Dexamethasone, and Cisplatin Regimen as an Effective Salvage Therapy for High-grade B-cell Lymphoma with MYC and BCL2 and/or BCL6 Rearrangements.
Authors: Mitobe M, Kawamoto K, Suzuki T, Kiryu M, Tamura S, Nanba A, Suwabe T, Tanaka T, Fuse K, Shibasaki Y, Masuko M, Miyoshi H, Ohshima K, Sone H, Takizawa J Abstract A 61-year-old woman exhibited right inguinal lymphadenopathy and right lower limb edema approximately 1 month prior to hospitalization. She was diagnosed with high grade B-cell lymphoma, and a lymph node biopsy and fluorescence in situ hybridization indicated MYC, BCL2, and BCL6 rearrangements (triple-hit lymphoma). She had progressive disease that was CD20-negative after two courses of R-CODOX-M/IVAC therapy. Subsequent EPOCH therapy was not effec...
Source: Internal Medicine - September 15, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Hemodynamic and Hormonal Effects of Tolvaptan for Heart Failure.
Authors: Kiuchi S, Ikeda T Abstract Tolvaptan (TLV) is a diuretic agent administrated for heart failure (HF) only in Japan. Many clinical findings have been obtained from the accumulation of clinical experience, and the administration of TLV reportedly avoids causing a reduction in the renal function. In addition, TLV has been reported to exert effects other than diuresis. The early start of TLV after hospitalization shortens the length of the hospital stay, and continuous TLV after discharge extends the period until re-hospitalization of HF patients. TLV is thought to function via vasopressin V2 receptor antagonis...
Source: Internal Medicine - September 15, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Ruptured Baker's Cyst in Rheumatoid Arthritis.
Authors: Nakamura J, Nagashima T, Akiyama Y, Minota S PMID: 30210136 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - September 15, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Hereditary Angioedema from 1888 to 2018 -Progress and Problems.
Authors: Horiuchi T PMID: 30210137 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - September 15, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Erythropoietic Protoporphyria-related Hepatopathy Successfully Treated with Phlebotomy.
Authors: Yoshida A, Hagiwara S, Watanabe T, Nishida N, Ida H, Sakurai T, Komeda Y, Yamao K, Takenaka M, Enoki E, Kimura M, Miyake M, Kawada A, Kudo M Abstract A 27-year-old man bearing an erythropoietic protoporphyria (EPP)-associated ferrochelatase (FECH) mutation was admitted to our hospital for general malaise and marked elevation of the serum levels of hepatobiliary enzymes and bilirubin. Initial treatment with plasma exchange did not reduce the blood protoporphyrin or serum liver enzyme levels, so phlebotomy was started. Surprisingly, weekly phlebotomy normalized the serum levels of liver enzymes, accompanied ...
Source: Internal Medicine - September 5, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Primary Oral Mucormycosis Due to Rhizopus microsporus after Allogeneic Stem Cell Transplantation.
Authors: Sakamoto H, Itonaga H, Sawayama Y, Taguchi J, Saijo T, Kuwatsuka S, Hashisako M, Kinoshita N, Oishi M, Doi H, Kosai K, Nishimoto K, Tanaka K, Yanagihara K, Mukae H, Izumikawa K, Miyazaki Y Abstract We herein report a rare case of oral mucormycosis following allogeneic hematopoietic stem cell transplantation. Oral mucormycosis due to Rhizopus microsporus manifested as localized left buccal mucositis with a 1-cm black focus before neutrophil recovery. Combination therapy with liposomal amphotericin B was initiated and surgical debridement was performed; however, the patient died due to progressive generalize...
Source: Internal Medicine - September 5, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Intravascular Large B-cell Lymphoma with a Pulmonary [18F]-Fluorodeoxyglucose Uptake.
Authors: Yamasaki M, Itagaki M, Taniwaki M, Asaoku H PMID: 30175729 [PubMed - in process] (Source: Internal Medicine)
Source: Internal Medicine - September 5, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

L-carnitine Improved the Cardiac Function via the Effect on Myocardial Fatty Acid Metabolism in a Hemodialysis Patient.
Authors: Kaneko M, Fukasawa H, Ishibuchi K, Niwa H, Yasuda H, Furuya R Abstract Patients on hemodialysis often have carnitine deficiency. We herein report a woman who experienced the dramatic improvement of cardiac dysfunction after intravenous L-carnitine administration. We also investigated the myocardial fatty acid metabolism using 123I-labeled β-methyl-p-iodophenyl-pentadecanoic acid (BMIPP) single-photon emission computed tomography (SPECT) before and after L-carnitine therapy, and the impaired metabolism was ameliorated. Taken together, these findings indicate that L-carnitine therapy improved cardiac dy...
Source: Internal Medicine - August 29, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Type 1 Diabetes Mellitus and Klinefelter Syndrome: A Case Report.
Authors: Teruaki S, Katsumi I, Takehiro K, Jun T Abstract A 60-year-old male patient with type 1 diabetes mellitus (T1DM) was admitted for glycemic control. The patient exhibited abdominal adiposity, osteoporosis, and high insulin requirement (>100 U), and we suspected hypogonadism. A physical examination revealed small testes and thin pubic hair, laboratory examination found high LH and FSH levels and low testosterone levels, and a chromosome analysis (47, XXY) indicated hypogonadism due to Klinefelter syndrome (KS). KS is associated with autoimmune diseases and patients positive for diabetes related auto-antib...
Source: Internal Medicine - August 29, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Hepatocellular Carcinoma in a Patient with Hereditary Hemorrhagic Telangiectasia.
Authors: Morii K, Uematsu R, Yamamoto T, Nakamura S, Okushin H, Nishiwaki N, Watanabe T, Kai K, Sato S Abstract A 76-year-old woman with hereditary hemorrhagic telangiectasia (HHT) showed elevated serum hepatobiliary enzyme levels, and abdominal imaging studies revealed a hepatic tumor. Her serum alpha-fetoprotein level was 759.5 ng/mL. A pathological examination after hepatectomy confirmed a diagnosis of hepatocellular carcinoma (HCC). An examination of the surrounding liver revealed dilated vessels and thickened endothelial cells without inflammations. HHT patients without other risk factors (like this patient) r...
Source: Internal Medicine - August 29, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Bronchial Occlusion with Endobronchial Watanabe Spigot for Hemoptysis in a Mechanically Ventilated Patient with Extracorporeal Circulation.
Authors: Sakaguchi T, Kida H, Kanno Y, Oyama B, Inoue T, Miyazawa T, Mineshita M Abstract Bronchial occlusion with endobronchial Watanabe spigots (EWSs) can be an essential therapeutic measure for treating massive hemoptysis in intensive care patients when no other conventional options are available. A 68-year-old-man on mechanical ventilation and extracorporeal circulation after cardiovascular surgery presented massive hemoptysis. He was deemed unfit for bronchial artery embolization (BAE) and surgery while in the intensive care setting; thus, bronchial occlusion was performed using EWSs. His hemoptysis ceased, an...
Source: Internal Medicine - August 29, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Successful Cord Blood Transplantation in a Werner Syndrome Patient with High-risk Myelodysplastic Syndrome.
Authors: Hayashi K, Tasaka T, Kondo T, Ishikawa Y, Goto M, Matsuhashi Y, Sadahira Y, Sugihara T, Hideho W Abstract Werner syndrome (WS) confers a high risk of the development of neoplasias, including hematological malignancies, and curative treatment for these malignancies is difficult to achieve. A 44-year-old man with myelodysplastic syndrome was admitted to our hospital. He was diagnosed with mutation-proven WS. He underwent cord blood transplantation (CBT) following fludarabine, busulfan, and melphalan administration. A chimerism analysis of his marrow blood on day 62 showed a donor pattern>95%, which confir...
Source: Internal Medicine - August 29, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Bronchodilator Reversibility Occurring during the Acute Phase of Paragonimiasis westermani Infection: A Case Report.
Authors: Harada T, Kawasaki Y, Tsukada A, Osawa Y, Takami H, Yamaguchi K, Kurai J, Yamasaki A, Shimizu E Abstract A 43-year-old woman was referred to our hospital with peripheral blood hyper eosinophilia and abnormal chest X-ray findings. Her pleural effusion revealed hypereosinophilia and a low glucose level. She was diagnosed with pulmonary paragonimiasis based on an elevated antibody level of Paragonimiasis westermani. Although she had no medical history of allergic disorders, a pulmonary function test revealed bronchodilator reversibility. After praziquantel therapy, her symptoms, hypereosinophilia in periphera...
Source: Internal Medicine - August 29, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Primary Cardiac Lymphoma: A Lesson Learned from an Unsuccessful Experience.
Authors: Ito I, Nakaoka Y, Kubokawa SI, Sugane H, Kusume T, Matsuda H, Imai RI, Nishida K, Kubo T, Yamasaki N, Kitaoka H, Kawai K, Hamashige N, Doi Y Abstract A 79-year-old man was admitted because of complete heart block. Echocardiograms showed an abnormal mass adjacent to the sinus of Valsalva. Subsequent surgical resection was not successful. Despite chemotherapy, the patient died from multiple organ failure. It is important to recognize that approximately 80% of cases of cardiac lymphoma are diffuse large B-cell lymphoma, which is the only malignant neoplasm that may respond well to chemotherapy with rituximab....
Source: Internal Medicine - August 29, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research