Japanese clinical medicine最新文献

{"title":"Analyzing the Factors Contributing to Withdrawal from Insulin Therapy Following Additional Administration of Alogliptin: Retrospective Study after Removing Glucotoxicity with Insulin.","authors":"Hiromi Hamamoto,&nbsp;Koji Nakanishi,&nbsp;Mitsuhiko Noda","doi":"10.4137/JCM.S27202","DOIUrl":"https://doi.org/10.4137/JCM.S27202","url":null,"abstract":"<p><p>We attempted to examine whether withdrawal from insulin therapy is or is not possible with administration of additional alogliptin and identify the contributing factors. The subjects were 43 adult patients with type 2 diabetes undergoing insulin therapy after admission. After glucotoxicity was removed, 25 mg alogliptin was additionally administered. Insulin was reduced by 15.6 ± 13.0 units (mean ± SD), and 17 patients (39.5%) completely withdrew from insulin therapy. Several factors were compared between the two groups of patients: those who could withdraw from insulin therapy and those who could not. The former group showed lower HbA1c levels on admission, a lower insulin dose before adding alogliptin, lower injection frequencies, and longer treatment histories prior to admission. Logistic regression analysis showed that lower insulin dose contributed significantly to withdrawal. These results suggest that a lower insulin dose is the best predictor for withdrawal from insulin therapy after adding alogliptin. </p>","PeriodicalId":89792,"journal":{"name":"Japanese clinical medicine","volume":"6 ","pages":"15-20"},"PeriodicalIF":0.0,"publicationDate":"2015-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4137/JCM.S27202","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34065574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Myasthenia Gravis in Patients with Elderly Onset at Advanced Age.","authors":"Noriko Nishikawa,&nbsp;Masahiro Nagai,&nbsp;Tomoaki Tsujii,&nbsp;Win T Kyaw,&nbsp;Nachi Tanabe,&nbsp;Hirotaka Iwaki,&nbsp;Hayato Yabe,&nbsp;Rina Ando,&nbsp;Masahiro Nomoto","doi":"10.4137/JCM.S29601","DOIUrl":"https://doi.org/10.4137/JCM.S29601","url":null,"abstract":"<p><p>The number of patients with late-onset myasthenia gravis (MG) among patients ≥50 years has been increasing recently. We encountered three patients who developed elderly-onset MG at a particularly advanced age (≥80 years). All were female and positive for anti-acetylcholine receptor antibodies. About 4 years have passed since MG onset in all three patients and symptoms have been controlled without recurrence using a combination of oral low-dose prednisolone and tacrolimus. As many cases of elderly-onset MG do not require strong immunosuppression, we recommend minimum immunosuppressive treatment to avoid adverse events, particularly in patients at an advanced age of ≥80 years. </p>","PeriodicalId":89792,"journal":{"name":"Japanese clinical medicine","volume":"6 ","pages":"9-13"},"PeriodicalIF":0.0,"publicationDate":"2015-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4137/JCM.S29601","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33994418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful prednisolone therapy in elderly patients with severe forms of henoch-schönlein purpura nephritis.","authors":"Saiko Kato-Okada,&nbsp;Hiromichi Suzuki,&nbsp;Tsutomu Inoue,&nbsp;Tomohiro Kikuta,&nbsp;Hirokazu Okada","doi":"10.4137/JCM.S23093","DOIUrl":"https://doi.org/10.4137/JCM.S23093","url":null,"abstract":"<p><strong>Introduction: </strong>Recently, Henoch-Schönlein purpura (HSP) has been observed in elderly people, although it was believed to be uncommon in these subjects. The increased risks of developing end-stage renal disease (ESRD) in adults in comparison with children were highlighted by different studies; however, limited data are available on the treatment of HSP nephritis in adults.</p><p><strong>Methods: </strong>Between 2002 and 2008, five elderly Japanese patients (>65 years old) (mean age, 68 years, ranging from 65 to 72) with severe forms of HSP nephritis were entered into a prospective study to evaluate prednisolone therapy on the outcome of nephropathy in terms of clinical symptoms and histopathological changes. The patients were considered at risk of developing chronic renal failure when they presented with a nephrotic syndrome and crescentic glomeruli.</p><p><strong>Results: </strong>At the last follow-up, 4-10 years after initiation of the therapy, four patients had clinically recovered and one died of lung cancer. No patients developed ESRD. The clinical outcome seemed to be correlated with glomerular activity (massive proteinuria and crescent formation). In spite of a relatively large dose of prednisolone, a few adverse effects, such as insomnia and skin lesions, were observed.</p><p><strong>Discussion: </strong>Our preliminary small study suggests that renal outcome as well as survival of elderly patients with severe forms of HSP might be altered by aggressive prednisolone therapy.</p>","PeriodicalId":89792,"journal":{"name":"Japanese clinical medicine","volume":"6 ","pages":"5-7"},"PeriodicalIF":0.0,"publicationDate":"2015-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4137/JCM.S23093","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33258012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case of fetal intestinal volvulus without malrotation causing severe anemia.","authors":"Tomoko Nakagawa,&nbsp;Daisuke Tachibana,&nbsp;Kohei Kitada,&nbsp;Yasushi Kurihara,&nbsp;Hiroyuki Terada,&nbsp;Masayasu Koyama,&nbsp;Yukari Sakae,&nbsp;Yoshiki Morotomi,&nbsp;Shiho Nomura,&nbsp;Mika Saito","doi":"10.4137/JCM.S20760","DOIUrl":"https://doi.org/10.4137/JCM.S20760","url":null,"abstract":"<p><p>Fetal intestinal volvulus without malrotation is a rare, life-threatening disease. Left untreated, hemorrhage from necrotic bowel tissue will lead to severe fetal anemia and even intrauterine death. We encountered a case of fetal intestinal volvulus causing severe anemia, which was diagnosed postnatally and successfully treated with surgical intervention. </p>","PeriodicalId":89792,"journal":{"name":"Japanese clinical medicine","volume":"6 ","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2015-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4137/JCM.S20760","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33333492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective Randomized Trial on Postoperative Administration of Diet Containing Eicosapentaenoic Acid, Docosahexaenoic Acid, Gamma-linolenic Acid, and Antioxidants in Head and Neck Cancer Surgery Patients with Free-flap Reconstruction.","authors":"Kiyoaki Tsukahara,&nbsp;Ray Motohashi,&nbsp;Hiroki Sato,&nbsp;Minoru Endo,&nbsp;Yuri Ueda,&nbsp;Kazuhiro Nakamura","doi":"10.4137/JCM.S18125","DOIUrl":"https://doi.org/10.4137/JCM.S18125","url":null,"abstract":"<p><strong>Objectives: </strong>The purpose of this prospective, randomized study was to evaluate the effects of a diet containing eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), gamma-linolenic acid (GLA), and antioxidants in head and neck cancer surgery patients with free-flap reconstruction.</p><p><strong>Methods: </strong>In this randomized, prospective study, 62 patients with head and neck cancers were assigned to receive a general control diet (Ensure(®) H; Abbott Japan, Tokyo, Japan) or the study diet (Oxepa(®); Abbott Japan) containing EPA, DHA, GLA, and antioxidants (eg vitamins A, E, and C). The primary assessment item was the degree of postoperative inflammation, as assessed by measuring maximum body temperature and levels of C-reactive protein (CRP) and procalcitonin from the day of surgery to postoperative day 8. Secondary assessment items were lengths of stays in the intensive care unit (ICU) and hospital.</p><p><strong>Results: </strong>The control diet group (n = 32) and study diet group (n = 30) showed no significant difference in energy administered through diet. No significant differences in the parameters of the primary assessment item were noted. Length of stay in the ICU was significantly shorter for the control diet group than for the study diet group (P = 0.011). No significant difference in duration of hospitalization was seen between groups.</p><p><strong>Conclusion: </strong>No usefulness of a diet containing EPA, DHA, GLA, and antioxidants was demonstrated.</p>","PeriodicalId":89792,"journal":{"name":"Japanese clinical medicine","volume":"5 ","pages":"47-54"},"PeriodicalIF":0.0,"publicationDate":"2014-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4137/JCM.S18125","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32790938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liraglutide Versus Sitagliptin in a 24-week, Multicenter, Open-label, Randomized, Parallel-group Study in Japanese Type 2 Diabetes Mellitus Patients Responding Inadequately to a Sulfonylurea and/or One or Two Other Oral Antidiabetic Drugs (JDDM 33).","authors":"Hiroki Yokoyama,&nbsp;Koichi Hirao,&nbsp;Kohei Yamaguchi,&nbsp;Mariko Oishi,&nbsp;Gendai Lee,&nbsp;Noriharu Yagi,&nbsp;Hiroshi Takamura,&nbsp;Atsunori Kashiwagi","doi":"10.4137/JCM.S16585","DOIUrl":"https://doi.org/10.4137/JCM.S16585","url":null,"abstract":"<p><strong>Objective: </strong>Liraglutide (glucagon-like peptide-1 [GLP-1] receptor agonist) and sitagliptin (dipeptidyl peptidase-4 inhibitor) are approved in Japan for treating type 2 diabetes mellitus (T2DM). We compared the efficacy and safety of adding liraglutide or sitagliptin to a sulfonylurea in Japanese T2DM patients.</p><p><strong>Methods: </strong>Patients aged 18 to <80 years with hemoglobin A1c (HbA1c; National Glycohemoglobin Standardization Program [NGSP]) of 6.9-9.4%, body mass index ≤35 kg/m(2), and treatment with a sulfonylurea and/or one or two non-sulfonylurea oral antidiabetic drugs for greater than or equal to eight weeks before enrollment were eligible. Patients were randomized in an open-label manner to either 0.9 mg/day liraglutide (n = 50) or 50-100 mg/day sitagliptin (n = 49) and were treated for 24 weeks. Non-sulfonylureas were discontinued before randomization. Patients using other oral antidiabetic drugs started sulfonylurea treatment. The primary endpoint was the change in HbA1c from baseline to Week 24.</p><p><strong>Results: </strong>HbA1c decreased in both groups, and the reduction was significantly greater throughout in the liraglutide group except for Week 24 (0.59 ± 0.80 vs. 0.24 ± 0.94%; P = 0.0525). Fasting plasma glucose (FPG) decreased significantly in the liraglutide group compared with the sitagliptin group (-21.15 ± 31.22 vs. +0.46 ± 39.39 mg/dL; P = 0.0014). Homeostasis model assessment of β cell function and C-peptide increased significantly in the liraglutide group but not in the sitagliptin group. Hypoglycemic symptoms and adverse events occurred in four and nine patients, respectively, in the liraglutide group, and in two and five patients, respectively, in the sitagliptin group.</p><p><strong>Conclusion: </strong>Treatment with liraglutide or sitagliptin together with a sulfonylurea improved HbA1c in Japanese T2DM patients in primary care. Both drugs were associated with low rates of adverse events and hypoglycemia. The improvement in β cell function probably contributed to the improvement in glycemic control in the liraglutide group.</p>","PeriodicalId":89792,"journal":{"name":"Japanese clinical medicine","volume":"5 ","pages":"33-41"},"PeriodicalIF":0.0,"publicationDate":"2014-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4137/JCM.S16585","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32724652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functioning endometrium and endometrioma in a patient with mayer-rokitanski-kuster-hauser syndrome.","authors":"Yasushi Kawano, Tomoko Hirakawa, Masakazu Nishida, Akitoshi Yuge, Mitsutake Yano, Kaei Nasu, Hisashi Narahara","doi":"10.4137/JCM.S12611","DOIUrl":"10.4137/JCM.S12611","url":null,"abstract":"<p><p>Mayer-Rokitanski-Kuster-Hauser (MRKH) syndrome is a rare disease. A 27-year-old woman was admitted for primary amenorrhea and cyclic pelvic pain. Magnetic resonance imaging (MRI) revealed bilateral Müllerian remnants with functioning endometrium and a pelvic mass considered to be an endometriotic cyst. Bilateral Müllerian remnants were removed, and right ovarian cystectomy was performed at laparoscopic surgery. Accurate evaluation before the operation and informed consent are necessary to treat patients with MRKH syndrome. </p>","PeriodicalId":89792,"journal":{"name":"Japanese clinical medicine","volume":"5 ","pages":"43-5"},"PeriodicalIF":0.0,"publicationDate":"2014-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4196889/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32763930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamic Change in Cells Expressing IL-1β in Rat Hippocampus after Status Epilepticus.","authors":"Satoru Sakuma,&nbsp;Daisuke Tokuhara,&nbsp;Hiroshi Otsubo,&nbsp;Tsunekazu Yamano,&nbsp;Haruo Shintaku","doi":"10.4137/JCM.S13738","DOIUrl":"https://doi.org/10.4137/JCM.S13738","url":null,"abstract":"<p><strong>Background: </strong>The time course of cytokine dynamics after seizure remains controversial. Here we evaluated the changes in the levels and sites of interleukin (IL)-1β expression over time in the hippocampus after seizure.</p><p><strong>Methods: </strong>Status epilepticus (SE) was induced in adult Wistar rats by means of intraperitoneal injection of kainic acid (KA). Subsequently, the time courses of cellular localization and IL-1β concentration in the hippocampus were evaluated by means of immunohistochemical and quantitative assays.</p><p><strong>Results: </strong>On day 1 after SE, CA3 pyramidal cells showed degeneration and increased IL-1β expression. In the chronic phase (>7 days after SE), glial fibrillary acidic protein (GFAP)-positive reactive astrocytes-appeared in CA1 and became IL-1β immunoreactive. Their IL-1β immunoreactivity increased in proportion to the progressive hypertrophy of astrocytes that led to gliosis. Quantitative analysis showed that hippocampal IL-1β concentration progressively increased during the acute and chronic phases.</p><p><strong>Conclusion: </strong>IL-1β affects the hippocampus after SE. In the acute phase, the main cells expressing IL-1β were CA3 pyramidal cells. In the chronic phase, the main cells expressing IL-1β were reactive astrocytes in CA1.</p>","PeriodicalId":89792,"journal":{"name":"Japanese clinical medicine","volume":"5 ","pages":"25-32"},"PeriodicalIF":0.0,"publicationDate":"2014-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4137/JCM.S13738","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32659609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurological Toxicity in Metastatic Colorectal Cancer Patients Treated with Modified FOLFOX6 Plus Bevacizumab.","authors":"Satoshi Otsu,&nbsp;Yoshinori Hirashima,&nbsp;Kazuo Nishikawa,&nbsp;Hiroyuki Sakashita,&nbsp;Ryotaro Morinaga,&nbsp;Koichiro Watanabe,&nbsp;Kuniaki Shirao","doi":"10.4137/JCM.S15553","DOIUrl":"https://doi.org/10.4137/JCM.S15553","url":null,"abstract":"<p><p>This study was conducted to investigate the toxicity and efficacy of modified FOLFOX6 plus bevacizumab in patients with metastatic colorectal cancer with particular regard to oxaliplatin-induced neuropathy. Toxicity was graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) (version 3.0). The evaluation was especially focused on grade 2 oxaliplatin-induced neuropathy. The estimated median treatment time to occurrence of grade 2 sensory neuropathy was 7.3 months. The estimated median cumulative dose to occurrence of grade 2 sensory neuropathy was 931 mg/m(2). This study clarified the treatment time from first dose as well as the cumulative dose of oxaliplatin leading to grade 2 neuropathy. It may be important to institute some clinical countermeasures when grade 2 neuropathy occurs so as to reduce the chance of progression to irreversible grade 3 neuropathy. </p>","PeriodicalId":89792,"journal":{"name":"Japanese clinical medicine","volume":"5 ","pages":"19-23"},"PeriodicalIF":0.0,"publicationDate":"2014-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4137/JCM.S15553","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32659608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case of giant osteoma in the middle turbinate of a child.","authors":"Minoru Endo,&nbsp;Kiyoaki Tsukahara,&nbsp;Kazuhiro Nakamura,&nbsp;Ray Motohashi,&nbsp;Mamoru Suzuki","doi":"10.4137/JCM.S15866","DOIUrl":"https://doi.org/10.4137/JCM.S15866","url":null,"abstract":"<p><p>Only seven cases of osteoma arising in the middle turbinate have been reported to date. We report the eighth case, involving osteoma in the middle turbinate of a child. This young boy was initially examined at the age of nine for the main complaint of nasal obstruction. Although a large osteoma with a maximum diameter of 30 mm was observed on computed tomography (CT), the patient was only observed because of the wishes of the family. At 13 years, he was again examined, as a result of worsening of the nasal obstruction. CT revealed that the osteoma had enlarged to a maximum diameter of 41 mm. Endoscopic surgery was attempted, but because of difficulties, the osteoma instead had to be removed under direct vision via a gingival incision. The final pathological diagnosis was osteoid osteoma. The nasal obstruction disappeared following surgery, with no recurrence after more than 12 months postoperatively. </p>","PeriodicalId":89792,"journal":{"name":"Japanese clinical medicine","volume":"5 ","pages":"15-8"},"PeriodicalIF":0.0,"publicationDate":"2014-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4137/JCM.S15866","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32432547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}