Internal medicine
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Case Reports
Symptomatic Long QT syndrome Coexisting with Asymptomatic Acetylcholine-induced Vasospasm.
We herein report a rare case of long QT syndrome (LQTS) coexisting with acetylcholine (Ach)-induced vasospasm. A 31-year-old woman experienced cardiopulmonary arrest during running. LQTS was diagnosed by an electrocardiogram, and the coexistence of Ach-induced vasospam was determined by an Ach provocation test on coronary angiography. Although an implantable cardioverter defibrillator was placed, a beta-blocker was not prescribed for two reasons: first, the patient showed Ach-induced vasospasm alone with no symptoms and no ST change by Ach injection, and second, the use of beta-blockers alone in such patients carries a risk of vasospasm-induced ventricular fibrillation.
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We herein report a 75-year-old man who developed disturbed consciousness with polynuclear cell dominant pleocytosis and low glucose and extremely high interleukin (IL)-6 levels in his cerebrospinal fluid. The biopsy specimen from his right supraclavicular lymph node showed the infiltration of inflammatory cells positive for IgG, IgG4 and IL-6. ⋯ However, he developed myelodysplastic syndrome (MDS) and died 18 months later. The extremely high IL-6 may have been related to the rare neurological manifestations and development of MDS in the present case.
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Case Reports
Conscious Hemiasomatognosia with No Somatosensory Disturbance Other Than a Unique Problem in Tactile Localization.
Conscious hemiasomatognosia is a disorder of the bodily self, involving subjective symptom where patients feel as if their whole body or part of one side has disappeared. Somatosensory disturbance is considered an essential component of conscious hemiasomatognosia. We herein report a 64-year-old man with conscious hemiasomatognosia of the right arm that developed after a left parietotemporal infarction, without any somatosensory disturbance except for a unique tactile localization problem. His response to the tactile localization test suggested impaired recognition of the positional relationship of his right arm relative to the entire body but normal recognition of positional relationships within the arm.
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Case Reports
Successful Conservative Treatment of Cardiac Rupture Associated with Takotsubo Syndrome.
We herein report a 75-year-old woman who was diagnosed with Takotsubo syndrome (TTS) complicated by left ventricular outflow tract obstruction on admission. Treatment with beta-blocker and anticoagulant was started; however, her hemoglobin level decreased gradually, and computed tomography performed one week later revealed hemopericardium. ⋯ It is noteworthy that cardiac rupture may occur with TTS, especially in patients treated with prophylactic anticoagulation therapy for apical thrombus. Furthermore, conservative, careful observation is an alternative approach in patients with oozing-type cardiac rupture associated with TTS.
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A 74-year-old man with a history of transfusion at 35 years old in Egypt was referred to our hospital. He was infected with hepatitis C virus (HCV) genotype 4 (GT4), which is a rare HCV GT in Japan, and was also diagnosed with hepatic compensated cirrhosis. We safely treated the patient for 12 weeks with the combination of glecaprevir and pibrentasvir, and a sustained virologic response (SVR) was achieved. This is the first report of HCV GT4 infection in a treatment-naïve Japanese patient with cirrhosis in whom SVR was achieved with the combination treatment of glecaprevir and pibrentasvir.