Internal medicine
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Amyopathic dermatomyositis (ADM) is a clinical subtype of dermatomyositis, characterized by the absence of motor weakness and the presence of normal muscle enzyme levels. ADM is sometimes accompanied by interstitial pneumonia that shows a rapid progressive course associated with a poor prognosis. We describe a 70-year-old man who presented rapidly progressive interstitial pneumonia associated with clinically ADM (C-ADM); he was successfully treated with polymyxin B-immobilized fiber column (PMX) hemoperfusion.
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Reduced glomerular filtration rate (GFR) is a risk factor of cardiovascular diseases. Accurate assessment of GFR together with early and appropriate treatment of chronic kidney disease (CKD) is important. Although the Japanese Society of Nephrology has recently announced two equations (equation 0.741 and equation 194) to estimate GFR for Japanese, the clinically significant estimated GFR (eGFR) in Japanese has not been identified. We examined the clinical significance of eGFR with regard hyperkalemia. ⋯ From the viewpoint of the increase in incidence of hyperkalemia, using an eGFR below 50 mL/min/1.73 m2 as the cutoff has clinical significance when equation 0.741 is used and a cutoff at 60 mL/min/1.73 m2 is appropriate when equation 194 is used.
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The transforming growth factor beta-1 gene (TGFB1) is one of the most promising candidate genes for chronic obstructive pulmonary disease (COPD). Several case-control studies have been performed and generated inconsistent results. The possible reasons for these discrepancies include the diversity of ethnic populations and the heterogeneity of COPD, including emphysema and airway disease. We designed this study to investigate the association of single nucleotide polymorphisms (SNPs) of TGFB1 with the emphysema phenotype in the Japanese population. ⋯ One significant haplotype of TGFB1 is associated with the emphysema phenotype in the Japanese population. Two TGFB1 SNPs (rs1800469 and rs1982073) are associated with the severity of COPD in patients with emphysema phenotype.
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Review Case Reports
Pancytopenia complicated with peripheral neuropathy due to copper deficiency: clinical diagnostic review.
Only a dozen cases of pancytopenia caused by copper deficiency have been reported. We report the case of an 81-year-old man who underwent total gastrectomy for gastric cancer. ⋯ The administration of copper into TPN led to rapid improvement in anemia and neutropenia. We review 11 previous cases of copper-deficient cytopenia, categorized into two groups according to etiology, and define the characteristic symptom of copper malabsorption caused by excess Zn as peripheral neuropathy.
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Case Reports
Severe respiratory failure and torsades de pointes induced by disopyramide in a patient with myasthenia gravis.
Class 1a anti-arrhythmic drugs are often used for the treatment of atrial fibrillation (AF), but it is not well known that myasthenia gravis (MG)-like symptoms can be generated by their anti-cholinergic effects. We had a patient with MG who developed symptomatic MG aggravation after AF treatment with disopyramide. Symptomatic MG aggravation was followed by Takotsubo-shaped cardiomyopathy, QT prolongation, and torsades de pointes. We suggest that the anti-cholinergic effects of disopyramide can induce MG crisis and should therefore be carefully considered when disopyramide is used to treat AF in patients with MG.