Internal medicine
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Objective The Glasgow Coma Scale (GCS) is widely used to assess the levels of consciousness. This study examined whether or not the initial GCS score could be a marker of the length of hospital stay (LOS) in patients with thyroid storm. Methods We retrospectively analyzed 29 patients with thyroid storm in our hospital between January 2010 and December 2023. ⋯ The baseline parameters that were significantly correlated with LOS were the GCS (ρ =-0.665; p <0.001) and SOFA score (ρ =0.670; p <0.001). The subsequent rank partial correlation analysis showed that GCS was still inversely correlated with LOS, independent of SOFA score (ρ =-0.390; p =0.040). Conclusions GCS, which can be evaluated more easily and quickly than the SOFA score, is a useful marker of LOS in patients with thyroid storm.
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Traditionally, leptomeningitis (LM) has been considered untreatable and terminal, but the development of epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) has significantly improved the prognosis of patients with EGFR mutations. However, non-LM lesions occasionally progress or recur, even when the LM is successfully controlled with EGFR-TKIs, and treatment of such cases remains unclear. We herein report a patient with advanced non-small-cell lung cancer (NSCLC) who was treated with an EGFR-TKI for LM and cytotoxic chemotherapy for EGFR-TKI-resistant pulmonary lesions. The patient survived for almost four years after the diagnosis of LM, suggesting that this treatment may be beneficial in advanced NSCLC with EGFR-TKI-sensitive LM and EGFR-TKI-resistant extracranial lesions.
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There are no clear strategies for non-insulin-dependent slowly progressive type 1 diabetes mellitus (SPIDDM). We herein report a 25-year-old man with SPIDDM in whom appropriate diet therapy and exercise improved the initial insulin secretion without medication. ⋯ These improvements were maintained over five years with continuous lifestyle interventions. Patients with non-insulin-dependent SPIDDM may recover and retain their insulin secretion through lifestyle interventions.
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A 74-year-old woman presented with sudden dyspnea 22 h after orthopedic surgery. Echocardiography revealed significant right ventricular dilatation, suggesting the development of acute pulmonary embolism. ⋯ After administration, her hemodynamic status improved promptly, and she soon showed normotension. The current case suggests the possibility of high-dose methylprednisolone for hemodynamic improvement in FES.
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A woman in her late 70s presented with a fever, rashes, and marked proximal muscle weakness. Noninfectious conditions, including myositis and vasculitis, were initially considered. ⋯ A skin biopsy revealed leukocytoclastic vasculitis with immune complex deposition, suggesting muscle damage due to immune complexes. This case underscores the need to consider JSF in patients with atypical symptoms and initiate timely treatment to prevent severe complications.