Internal medicine
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Case Reports
Advanced Hirayama disease with successful improvement of activities of daily living by operative reconstruction.
Juvenile muscular atrophy of the distal upper extremity (Hirayama disease) is a benign and non-progressive motor neuron disease. Application of a cervical collar is believed to prevent progression of symptoms in the early stages, but there is no effective therapy for the advanced disease. We found that tendon transfer improved the activities of daily living (ADL) of a patient with advanced Hirayama disease. An operative reconstruction can be valuable, even in patients with Hirayama disease who have developed impaired ADL due to extensive intrinsic hand muscle atrophy.
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We report a case of pulmonary hyalinizing granuloma (PHG) with laryngeal and subcutaneous involvement. A 43-year-old man was admitted to our hospital for assessment of hoarseness. ⋯ The histopathology of biopsy specimens from both the laryngeal tumor and a subcutaneous tumor resembled that of the resected lung masses. Although there is no established treatment for PHG, the laryngeal tumor was diminished and all other lesions disappeared with glucocorticoid treatment.
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We report a case of a 62-year-old man diagnosed as Crow-Fukase syndrome (POEMS syndrome), in which the serial platelet count and vascular endothelial growth factor (VEGF) concentration were determined before and during the state of disseminated intravascular coagulation (DIC). The serum VEGF concentration was noted to be gradually decreased prior to DIC, after which it abruptly decreased with a corresponding drop in platelet count upon the onset of DIC. The physiological effects of VEGF are viewed as one of the causative factors in DIC and its abrupt and excessive release may have caused the exacerbation of the patient's clinical symptoms.
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A 45-year-old man developed severe arterial hypertension associated with unusual hyperintensity in the brainstem, around the right internal capsule and in the deep white matter around the bilateral anterior horn of the lateral ventricle on T2-weighted and fluid-attenuated inversion-recovery images. The characteristic clinical findings were mild left hepiparesis and altered mental status which corresponded to the lesions of MR imagings. The lesions improved gradually with improvements in hypertension, which suggested that edema could be the principal cause of the unusual hyperintensity on MR images.
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Case Reports
Cigarette smoking-induced acute eosinophilic pneumonia showing tolerance in broncho-alveolar lavage findings.
A 19-year-old man was admitted due to acute respiratory failure. He had started cigarette smoking (CS) about three weeks prior to onset. Multiple nodular shadows and patchy infiltrations were found on chest computed tomography. ⋯ We suspected CS-induced acute eosinophilic pneumonia and performed broncho-alveolar lavage (BAL) about one month after onset. The proportion of eosinophils in BAL fluid was 72%. A second BAL was performed about 18 months after onset and BAL fluid included no eosinophils, despite the fact that he had continued CS.