Internal medicine
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A 71-year-old man was admitted with malaise, mild fever, anorexia, body weight loss, lower back pain, thirst, and polydipsia. He showed bilateral swelling of the submandibular glands. Examinations showed panhypopituitarism and a high serum IgG4 concentration. ⋯ Biopsy specimens from the submandibular gland and retroperitoneal mass indicated sialadenitis and retroperitoneal fibrosis respectively, and showed severe fibrosis and inflammation with marked lymphoplasmacytic infiltration and IgG4-positive plasma cell infiltration. Hormone replacement therapy with hydrocortisone resulted in marked clinical improvement. Systemic involvement found in this patient possibly corresponded to the new concept of IgG4-associated multifocal systemic fibrosis.
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A 64-year-old man with repetitive gastrointestinal bleeding was admitted to our hospital. Colonic artery angiography revealed angiodysplasia as the bleeding site, and echocardiography showed aortic valve stenosis. ⋯ Following colectomy, the patient showed a good clinical course without recurrent gastrointestinal bleeding. Colectomy might serve as a therapeutic option for Heyde syndrome after the precise site of angiodysplasia is detected by angiography.
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A 20-year-old man with a 15 pack-year history of cigarette smoking had a tattoo outlined on his back with blue pigment. He noticed a dry cough and shortness of breath on exertion when the pigment of other colors was added at the age of 27. ⋯ He was diagnosed with desquamative interstitial pneumonia by surgical lung biopsy. Steroid therapy with cessation of smoking was partially effective, however his disease worsened again and he died three and a half years after the diagnosis because of respiratory failure.
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Clinical Trial
Characteristics of asthma resistant to moderate dose inhaled corticosteroid treatment on bronchial hyperresponsiveness.
This study was performed to determine the clinical characteristics of asthmatics with bronchial hyperresponsiveness (BHR) that could not be normalized by 6 months of treatment with a moderate dose of an inhaled corticosteroid (ICS). ⋯ These findings suggest that the resistance to a moderate dose of ICS for BHR in asthmatics may be significantly associated with remained airflow limitation, eosinophilic airway inflammation resistive to moderate dose of ICS, and delayed introduction of ICS therapy.
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Case Reports
Glucocorticoid therapy ameliorated hypoglycemia in insulin-like growth factor-II-producing solitary fibrous tumor.
A 54-year-old man with a past history of multi-operation for solitary fibrous tumor was hospitalized for hypoglycemia. Computed tomography demonstrated multiple tumors in the liver but not in the pancreas. His serum insulin-like growth factor (IGF)-II level was normal, but immunoblot analysis and immunohistochemistry revealed a high molecular weight form of IGF-II in the serum and tumor. ⋯ Hypoglycemia was repeated despite infusion of glucose and glucagon. Glucocorticoid dramatically and continuously abolished hypoglycemia. In cases of inoperable IGF-II-producing tumor, glucocorticoid therapy may be promising for hypoglycemia.