Internal medicine
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Pheochromocytoma is a rare, catecholamine-secreting tumor. The classic symptoms are headache, diaphoresis, and tachycardia with paroxysmal hypertension. ⋯ They were diagnosed with pheochromocytoma and underwent laparoscopic adrenectomy that restored cardiac function. These cases illustrate diagnostic and management considerations in pheochromocytoma complicated by acute myocarditis and cardiogenic shock.
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Case Reports
Two Japanese CADASIL families exhibiting Notch3 mutation R75P not involving cysteine residue.
Most previously reported mutations in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) result in an odd number of cysteine residues within the epidermal growth factor (EGF)-like repeats in Notch3. We report here R75P mutation in two Japanese CADASIL families not directly involving cysteine residues located within the first EGF-like repeats. Probands in both families had repeated episodes of stroke, depression, dementia as well as T2 high-intensity lesions in the basal ganglia and periventricular white matter, but fewer white matter lesions in the temporal pole on MRI. These families provide new insights into the diagnosis and pathomechanisms of CADASIL.
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Comparative Study
Long-term intensive insulin therapy for Japanese patients with type 2 diabetes mellitus.
To determine the clinical usefulness of long-term intensive insulin therapy in Japanese patients with type 2 diabetes. ⋯ Our results indicated the clinical usefulness of intensive insulin therapy over the long term in Japanese patients with type 2 diabetes and that such therapy could be especially useful for previously untreated patients.
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Case Reports
Cerebellar hemorrhage provoked by combined use of nattokinase and aspirin in a patient with cerebral microbleeds.
Nattokinase is used as a health-promoting medicine for preventing thrombosis due to its fibrinolytic activity. Cerebral microbleed is remnant of blood extravasations from the damaged vessels related to cerebral microangiopathies. ⋯ In addition to the hemorrhagic lesion, multiple microbleeds were demonstrated on brain MR images. We suggest that nattokinase may increase risk of intracerebral hemorrhage in patients who have bleeding-prone cerebral microangiopathy and are receiving other antithrombotic agent at the same time.
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Case Reports
Superior vena cava syndrome caused by an intravascular thrombosis due to underlying prostate carcinoma.
Superior vena cava (SVC) syndrome is usually caused by malignant tumors or their lymph node metastases oppressing a SVC. However, we encountered a case of SVC syndrome that was caused by a thrombus in the SVC, which we considered as a manifestation of Trousseau's syndrome triggered by underlying prostate cancer. A 60-year-old man patient complained of facial swelling. ⋯ Histological examination of both percutaneous transluminally aspirated thrombus via a catheter through jugular vein and the axillary lymph nodes included metastatic prostate cancer. Although the ultrasonic and MR images were not compatible with the prostate cancer, needle biopsies from the prostate established the diagnosis. The SVC syndrome as an initial manifestation of underlying unknown malignancy and also due to intravascular thrombosis caused by cancer metastasis to the vascular wall is extremely uncommon.