Internal medicine (Tokyo, Japan)最新文献

{"title":"A Case of Hepatic Cyst Infection in a Hemodialysis Patient with Autosomal Dominant Polycystic Kidney Disease Complicated by Non-symptomatic Caroli Disease.","authors":"Ayaka Hane, Tatsuya Suwabe, Yuki Oba, Shigekazu Kurihara, Hiroki Mizuno, Hisashi Kamido, Hisashi Sugimoto, Noriko Inoue, Akinari Sekine, Masayuki Yamanouchi, Kiho Tanaka, Eiko Hasegawa, Takehiko Wada, Naoya Mirisada, Kandai Nozu, Naoki Sawa, Yoshifumi Ubara","doi":"10.2169/internalmedicine.5486-25","DOIUrl":"https://doi.org/10.2169/internalmedicine.5486-25","url":null,"abstract":"<p><p>An 84-year-old woman undergoing hemodialysis for autosomal dominant polycystic kidney disease (ADPKD) was admitted for refractory hepatic cyst infection. Magnetic resonance cholangiopancreatography and contrast-enhanced computed tomography revealed a concurrent complication of Caroli disease, diagnosed by cystic dilatation of the intrahepatic bile duct and a central dot sign in the vicinity of the infected liver cyst. However, there was no traffic between the infected liver cyst and dilated bile duct, and the cyst drainage procedure was curative. In cases where both diseases were combined, it was suggested that two infections, cyst and biliary tract infections, could occur.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144652039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility and Safety of Decortication Using Medical Thoracoscopy under Local Anesthesia Performed by Respiratory Physicians in Patients with Acute Pleural Empyema: A Single-center Retrospective Study.","authors":"Koki Nakashima, Takayuki Azuma, Masayuki Sato, Kazunari Igarashi, Tamotsu Ishizuka","doi":"10.2169/internalmedicine.5728-25","DOIUrl":"https://doi.org/10.2169/internalmedicine.5728-25","url":null,"abstract":"<p><p>Objective Acute pleural empyema, defined as empyema diagnosed within three months of the onset, frequently affects patients with poor general health and often poses challenges for invasive treatments requiring general anesthesia. In addition, the number of respiratory surgeons was insufficient and unevenly distributed across urban base and core hospitals in Japan. Therefore, safe and effective therapeutic procedures that physicians can perform are required. Methods We retrospectively analyzed 28 patients with acute pleural empyema who underwent decortication using medical thoracoscopy under local anesthesia (DMT-LA) in our department. All procedures were performed by respiratory physicians at our institution. The \"success\" of DMT-LA was defined by meeting all of the following criteria: (i) absence of residual clinically significant pleural effusion, (ii) resolution of clinical signs of sepsis, (iii) normalization of serum C-reactive protein (CRP) levels and white blood cell counts, (iv) no requirement for additional interventions, and (v) maintenance of these conditions for at least one month following antibiotic treatment. Results Of the 28 patients, 21 met the criteria for success, yielding a success rate of 75.0%. Patients in the failure group were more likely to have an Eastern Cooperative Oncology Group-performance status of >3, stage III empyema, and high median serum CRP levels than those in the success group. Adverse events were observed in only one patient (3.4%) and involved prolonged sedative effects. Conclusions DMT-LA is a safe and effective therapeutic procedure that can be performed by respiratory physicians and provides a viable treatment option for acute pleural empyema, particularly in facilities without respiratory surgeons.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144652051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cold Forceps Polypectomy with Jumbo Forceps for Foveolar-type Gastric Adenoma with a Raspberry-like Appearance in an Outpatient Setting.","authors":"Junnosuke Hayasaka, Daisuke Kikuchi, Kei Kouno, Yutaka Takazawa, Shu Hoteya","doi":"10.2169/internalmedicine.5659-25","DOIUrl":"https://doi.org/10.2169/internalmedicine.5659-25","url":null,"abstract":"<p><p>The optimal endoscopic treatment for foveolar-type gastric tumors with raspberry-like appearance remains unclear. A 51-year-old man underwent endoscopic treatment for a 4-mm foveolar-type gastric tumor with a raspberry-like appearance. Because the patient preferred outpatient treatment, resection was performed using cold forceps polypectomy with jumbo forceps. Both the gross and pathological margins were negative, and the tumor was successfully resected without complications. This case suggests that cold forceps polypectomy with jumbo forceps may be a suitable and minimally invasive treatment for small foveolar-type gastric tumors with a raspberry-like appearance.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144652042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Anti-NH2 Terminal of α-enolase Antibody-positive Hashimoto's Encephalopathy with Bilateral Basal Ganglia Lesions: A Case Report and Literature Review.","authors":"Yu Matsuda, Mitsuhiro Kainaga, Mizue Maeda, Hideki Kitao, Shinichi Tokushige, Ayumi Uchibori, Chizuko Oishi, Yaeko Ichikawa","doi":"10.2169/internalmedicine.5692-25","DOIUrl":"https://doi.org/10.2169/internalmedicine.5692-25","url":null,"abstract":"<p><p>Hashimoto's encephalopathy (HE) is a type of encephalopathy characterized by neuropsychiatric symptoms, high serum anti-thyroid antibody concentrations, and good responsiveness to immunotherapy. We herein report a rare case of HE with positive serum anti-NH2 terminal of α-enolase (NAE) antibodies and abnormal findings in the bilateral basal ganglia on brain magnetic resonance imaging (MRI). In cases presenting with isolated lesions in the basal ganglia, HE should not be excluded from the differential diagnosis, particularly when other causes are excluded and serum anti-thyroid antibodies are elevated. In such cases, testing for anti-NAE antibodies may aid in the diagnosis.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Azacitidine Plus Venetoclax in Acute Myeloid Leukemia Transformed from Myelodysplastic Syndrome after Failure of Azacitidine Monotherapy.","authors":"Takafumi Furumoto, Koji Ando, Eo Toriyama, Tomoko Hata, Shinichi Katsuoka, Saori Nishimura, Masamitsu Ichinose, Miki Hashimoto, Machiko Fujioka, Chika Sakaki, Hikaru Sakamoto, Masahiko Chiwata, Rena Kamijo, Yuji Kobayashi, Hideaki Kitanosono, Jun Nakashima, Takeharu Kato, Masataka Taguchi, Makiko Horai, Masatoshi Matsuo, Junya Makiyama, Hidehiro Itonaga, Shinya Sato, Maki Baba, Yasushi Sawayama, Yumi Takasaki, Jun Taguchi, Daisuke Imanishi, Yoshitaka Imaizumi, Yasuhisa Kawaguchi, Hideki Tsushima, Tatsuro Jo, Shinichiro Yoshida, Yukiyoshi Moriuchi, Yasushi Miyazaki","doi":"10.2169/internalmedicine.5312-25","DOIUrl":"https://doi.org/10.2169/internalmedicine.5312-25","url":null,"abstract":"<p><p>Objective Patients with acute myeloid leukemia (AML) transformed from myelodysplastic syndrome (MDS) have a poor prognosis, including those treated with azacitidine during the MDS phase; there is no standard for the care of these patients. Recently, azacitidine plus venetoclax (AZA/VEN) was reported to prolong the survival in treatment-naïve AML patients compared with AZA monotherapy. However, the results of AZA/VEN for AML transformed from MDS, particularly after AZA monotherapy, remain unclear. The present study therefore compared the clinical results of AZA/VEN treatment in these patients. Methods and Patients Data from MDS patients diagnosed at 10 institutions in Nagasaki Prefecture were collected. Thereafter, patients with transformed AML following AZA monotherapy during the MDS phase were selected, and their treatment response and survival were analyzed. Results The overall response (OR) rate, overall survival (OS), and event-free survival (EFS) were compared among patients treated with AZA/VEN (n=13), chemotherapy (intensive and low-intensity, n=35), AZA monotherapy (mAZA, n=15), and best supportive care (BSC, n=43) after AML transformation. The corresponding OR rates were 38.5%, 20.0%, and 6.7% for the AZA/VEN, chemotherapy, and mAZA groups, respectively (p=0.235). The respective median OS and EFS were 10.7 and 8.9 months for AZA/VEN, 3.2 and 2.0 months for chemotherapy, and 3.8 and 2.7 months for mAZA, and 1.7 months for BSC (OS only) (p=0.000023 for the OS and p=0.026 for the EFS), Conclusion Our findings suggest the superiority of AZA/VEN for AML patients with transformation from MDS following AZA monotherapy.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lung Abscess with Empyema Caused by Streptococcus Pyogenes.","authors":"Jiro Fujita, Tetsu Chinen, Kazutaka Yamaniha, Motoo Baba","doi":"10.2169/internalmedicine.5852-25","DOIUrl":"https://doi.org/10.2169/internalmedicine.5852-25","url":null,"abstract":"","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Efficacy of Dapagliflozin in Cases of Advanced Renal Dysfunction in Chronic Kidney Disease.","authors":"Yoshihiko Imamura, Hayato Wakabayashi, Toshihide Hayashi, Yasunori Takahashi","doi":"10.2169/internalmedicine.5764-25","DOIUrl":"https://doi.org/10.2169/internalmedicine.5764-25","url":null,"abstract":"<p><p>Objective The present study investigated the various clinical effects of dapagliflozin in chronic kidney disease (CKD) and its efficacy in patients with advanced renal dysfunction. Methods A total of 94 CKD cases (non-diabetic, 58; diabetic, 36) were treated with dapagliflozin (10 mg) in an outpatient setting for 12 months. The estimated glomerular filtration rate (eGFR) was measured during the 12 months before and after, with laboratory findings determined at the baseline and at 12 months after dapagliflozin administration. In addition, the annual decrease in the eGFR (eGFR slope) was compared before and one year after the baseline readings, and the eGFR slope values before and after dapagliflozin administration in 34 rapid decliner cases with an eGFR slope >5 mL/min/1.73 m²/year before dapagliflozin administration and 19 cases with an eGFR <25 mL/min/1.73 m² at baseline were compared. Results The body mass index, blood pressure, uric acid, and urine protein-to-creatinine ratio significantly decreased, and hemoglobin levels significantly increased after dapagliflozin administration. There was a significant increase after administration in the mean eGFR slope of all cases, rapid decliners, and cases with an eGFR <25 mL/min/1.73 m² at baseline (all p<0.001). Furthermore, there was a higher ratio of improvement in the eGFR slope in 39 patients who underwent multidisciplinary care within 1 year of dapagliflozin administration. Conclusion Dapagliflozin is effective in preventing renal function decline in patients with rapidly worsening or advanced CKD, with the effect further enhanced after combination with multidisciplinary care.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risks and Benefits of Obinutuzumab-Based Chemotherapy in the Context of SARS-CoV-2 Infection.","authors":"Kohei Shiroshita, Himari Kudo, Miki Sakamoto, Takaaki Toyama","doi":"10.2169/internalmedicine.5962-25","DOIUrl":"https://doi.org/10.2169/internalmedicine.5962-25","url":null,"abstract":"","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful Remission of Nephrotic Syndrome Caused by IgA Nephropathy with Membranoproliferative Glomerulonephritis-pattern Lesion Treated by Cyclosporine and Oral Corticosteroids.","authors":"Yuki Nakao, Yutaro Mori, Junko Kunieda, Towako Taguchi, Katsuo Mori, Ayumi Yamamura, Shotaro Naito, Fumiaki Ando, Shintaro Mandai, Soichiro Iimori, Koichiro Susa, Takayasu Mori, Kenichi Ohashi, Eisei Sohara, Shinichi Uchida","doi":"10.2169/internalmedicine.5526-25","DOIUrl":"https://doi.org/10.2169/internalmedicine.5526-25","url":null,"abstract":"<p><p>Introduction Immunoglobulin A nephropathy (IgAN) is a common glomerular renal disease presenting with mesangial cell proliferation and mesangial matrix hyperplasia and is typically treated with oral glucocorticoids. However, the clinical presentations and treatment strategies for certain cases of oral glucocorticoid-resistant IgA nephropathy have not been established. Clinical Presentation We herein report a case of recurrent IgA nephropathy presenting with nephrotic syndrome and membranoproliferative glomerulonephritis-pattern lesions. A 42-year-old woman presented to our clinic 22 years ago after urinary occult blood was detected during a health examination, leading to a diagnosis of IgA nephropathy based on a renal biopsy. Although temporary remission was achieved with oral glucocorticoid therapy, the relapse occurred repeatedly. Eight years ago, she underwent a third renal biopsy, which revealed grade II (C) and Oxford classification M1E0S1T0 findings. Temporary remission was achieved following tonsillectomy and steroid pulse therapy. Subsequently, she presented with nephrotic syndrome and rapidly increasing urinary protein levels. A fourth renal biopsy revealed membranoproliferative glomerulonephritis (MPGN) pattern lesions that were not previously observed. The administration of cyclosporine and corticosteroids after steroid pulse therapy led to complete remission. Conclusion In cases of recurrent IgA nephropathy complicated by nephrotic syndrome, MPGN-pattern lesions may underlie this condition. In these cases, both corticosteroids and additional cyclosporine may be effective.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peritonitis due to Ruptured Splenic Abscess Managed by Trans-gastric Endoscopic Ultrasonography-guided Dual Drainage Combined with Lavage and Intermittent Negative Pressure: A Case Report and Literature Review.","authors":"Tesshin Ban, Yoshimasa Kubota, Naoto Imura, Shun Sasoh, Satoshi Tanida, Makoto Nakamura, Tomoaki Ando, Takashi Joh","doi":"10.2169/internalmedicine.5773-25","DOIUrl":"https://doi.org/10.2169/internalmedicine.5773-25","url":null,"abstract":"<p><p>There are no established guidelines for managing patients with rare but fatal ruptured splenic abscesses. In this clinical scenario, open splenectomy seems to be a standard literature-based intervention. However, open splenectomy under general anesthesia is not a priority in high-risk surgical patients. We herein report an endoscopic ultrasound-guided transmural dual drainage combined with lavage and intermittent negative pressure drainage as an alternative to surgery for a critical patient with a ruptured splenic abscess and discuss the benefits and drawbacks of open splenectomy as a case report and literature review.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}