Internal medicine
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Objective Patients with advanced interstitial lung disease (ILD) struggle to undergo spirometry to evaluate the respiratory function. The cardiothoracic ratio (CTR) on chest radiography can potentially reflect the lung volume; however, this has not yet been fully established. This study aimed to clarify the relationship between the CTR and the respiratory function in patients with interstitial lung diseases. ⋯ The CTR was significantly negatively correlated with the vital capacity (r = -0.490, p <0.001). Conclusions An increased CTR might reflect a decreased vital capacity, but not a decreased cardiac function, in patients with interstitial lung diseases. Measuring the CTR can thus be beneficial for predicting progression in patients with ILD.
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A 58-year-old woman was admitted to our hospital with anasarca and generalized lymphadenopathy. Laboratory data showed serum Cr 1.48 mg/dL, CRP 2.38 mg/dL, PLT 102,000/μL, and anti-SS-A antibodies (SS-A-ab). ⋯ Her body weight decreased from 59.4 to 41 kg, and pleural effusion disappeared 8 weeks later. This case suggests that TAFRO-like symptoms may occur in patients with Sjögren's syndrome with HTLV-1 infection.
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Pulse oximetry is used to screen for respiratory failure in dyspnea patients. However, pulse oximetry can yield false-positive results in certain situations. Unstable hemoglobinopathy is a disease in which mutations in the globin-encoding gene result in abnormal globin chain production, causing low percutaneous oxygen saturation (SpO2) levels due to changes in hemoglobin absorbance and oxygen affinity. ⋯ According to our literature review, only a few cases of unstable hemoglobinopathy have been reported in adults. Most patients with unstable hemoglobinopathy are asymptomatic, and those with dyspnea often have respiratory diseases or severe anemia. To differentiate unstable hemoglobinopathy, an appropriate assessment of the discrepancy between SpO2 values and arterial blood gas analysis results is important.
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Macrophage activation syndrome (MAS) involves an excessive amount of acute inflammatory responses to inflammatory cytokines, particularly interleukin-6 (IL-6). IL-6 is also strongly associated with the pathophysiology of certain neuroimmunological diseases. ⋯ Standard immunosuppressive therapies could not stabilize the symptoms in our cases until antibodies against the IL-6 receptor were administered. This finding suggests that it is important to consider the underlying pathophysiology of MAS in relation to these neuroimmunological diseases when treating affected patients.
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A 44-year-old woman underwent a follow-up examination for Crohn's disease 9 years ago. Chest computed tomography (CT) showed an infiltration shadow with a cavity in the right upper lobe. ⋯ Mycobacterium heckeshornense was isolated from the bronchoalveolar lavage fluid specimen, so we diagnosed her with pulmonary M. heckeshornense disease. Isoniazid, rifampicin, and ethambutol were administered, and the abnormal chest shadow improved.