Internal medicine
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A 45-year-old man was diagnosed with CML in the chronic phase and therefore was sequentially treated with imatinib, dasatinib, nilotinib, and ponatinib. Neither ABL1 point mutations nor any additional chromosomal abnormalities were detected. ⋯ Two years after ponatinib administration, the patient died of a traumatic brain hemorrhage 15 years after the CML diagnosis. He did not progress to blast crisis, possibly because of the emergence of a loss-of-function ABL1 splicing variant.
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Objective Metabolic-associated fatty liver disease (MAFLD) has only recently been proposed; therefore, the characteristics of patients with autoimmune hepatitis (AIH) and MAFLD remain unclear. This study evaluated the effect of MAFLD on AIH patients with AIH. Methods We reevaluated the Japanese Nationwide Survey of AIH in 2018, which involved a survey of patients diagnosed with AIH between 2014 and 2017. ⋯ However, the levels of hepatobiliary enzymes and total bilirubin after treatment were significantly higher in AIH patients with MAFLD than in those without MAFLD. Conclusion AIH patients with MAFLD had characteristics different from those of AIH patients without MAFLD. These findings could help increase our understanding of patients with AIH with MAFLD.
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Case Reports
Two Cases of Gastric Adenocarcinoma with Enteroblastic Differentiation which Demonstrated Rapid Progressive Courses.
We herein report two extremely rare cases of gastric adenocarcinoma with enteroblastic differentiation (GAED) that underscore the aggressive nature of GAED. Case 1: endoscopic submucosal dissection (ESD) was scheduled for early-stage gastric cancer, however, the tumor increased in size drastically and the morphology changed to type "0-I + IIc" in one month. Surgery was performed and the patient was diagnosed with GAED. ⋯ The horizontal margin was positive for clear cells in the muscularis mucosa. Additional surgery was performed; however, recurrence occurred one year later. Therefore, the treatment strategies should be carefully considered for GAED.
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A 75-year-old man with a fever, shoulder pain, and lower leg edema was diagnosed with polymyalgia rheumatica and started on glucocorticoid therapy. Eighteen months later, he was admitted with rapidly progressive renal failure. Glucocorticoid therapy had been discontinued one month prior to admission. ⋯ Polyarteritis nodosa was diagnosed based on the presence of fibrinoid necrosis in the medium-sized renal arteries. Glucocorticoid pulse therapy and plasmapheresis were initiated, but the patient died of alveolar hemorrhaging. This was a rare case of Goodpasture syndrome with polyarteritis nodosa.
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The patient was a 36-year-old woman in the 34th week of pregnancy who presented with headache. Magnetic resonance imaging (MRI) revealed bilateral internal carotid artery (ICA) stenosis and inflammatory changes in the sphenoid sinus. No cerebral infarction was detected on diffusion-weighted magnetic MRI. ⋯ Her headache improved, and MRI showed remarkable improvement in bilateral ICA stenosis and no cerebral infarction. Severe sinusitis can also cause ICA stenoses. An early diagnosis and appropriate treatment of causative sinusitis can improve ICA stenosis and prevent stroke.