Internal medicine
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Case Reports
New-onset Polymyalgia Rheumatica Following the Administration of the Pfizer-BioNTech COVID-19 Vaccine.
We herein report the case of an 80-year-old Japanese woman who presented to our hospital with bilateral pain in the shoulders and hips lasting for a month since 2 days after the second dose of the BNT162b2 COVID-19 vaccine. Her physical findings, laboratory data, and ultrasonographic findings of bilateral biceps tenosynovitis and lateral subacromial bursitis were consistent with a diagnosis of polymyalgia rheumatica (PMR). She was successfully treated with oral prednisolone 15 mg/day. Although a causal relationship could not be definitively confirmed, PMR should be considered as a differential diagnosis in cases of persistent myalgia after administration of the BNT162b2 vaccine.
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Objective To evaluate the change in the prevalence of burnout during the COVID-19 pandemic among internists and primary care physicians in Japan, and to identify factors associated with the exacerbation of burnout among these populations during this period. Methods This was a cross-sectional study based on two web-based surveys conducted in January 2020 (before the declaration of the COVID-19 pandemic) and June 2020 (during the pandemic). The participants were internists and primary care physicians of the Japanese Chapter of the American College of Physicians. ⋯ Only the experience of self-quarantine was associated with the exacerbation of burnout [odds ratio (OR) 3.12; 95% confidence interval (CI) 1.49-6.50; p=0.002], while being a woman, being a resident physician, and an experience of having worked in a prefecture under a state of emergency were not. Conclusions No marked change in the prevalence of burnout among internists and primary care physicians in Japan was observed during the COVID-19 pandemic as a whole. However, self-quarantine was associated with the exacerbation of the burnout level.
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Case Reports
A Case of a Lotus Root-like Appearance in the External Iliac Artery Detected by Intravascular Ultrasonography.
A lotus root-like appearance on blood vessels is a rare abnormality. The multiple channels within arteries may represent the recanalization or neovascularization of the thrombus. This abnormality is most frequently found in coronary arteries. ⋯ We subsequently performed an endovascular treatment six months later due to intermittent claudication. A lotus root-like appearance was found on intravascular ultrasound. To our knowledge, this is the first study to report a case of lotus root-like appearance in lower-extremity arteries.
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Case Reports
Amelanotic Malignant Melanoma with a BRAF V600E Mutation Mimicking Primary Lung Cancer.
Amelanotic melanoma is a rare type of melanoma that shows little or no melanin pigmentation. When tumor lesions are not detected in cutaneous sites, the presence of melanin is the hallmark sign of malignant melanoma. ⋯ The current case suggests important caveats for the differential diagnosis of patients with BRAF V600E mutation-positive poorly differentiated lung tumors. In terms of the pathological diagnosis, routine immunohistochemical staining may be useful, especially in patients with a poorly differentiated lung tumor without TTF-1 expression.
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Dendriform pulmonary ossification is a rare condition characterized by branching bony spicules. A 33-year-old man was clinically considered to have sarcoidosis. At 53 years old, another attending physician performed a detailed evaluation. ⋯ A histological examination revealed dendriform pulmonary ossification. After surgery, CT showed progression of some lesions; the pulmonary function had also decreased slightly. Since dendriform pulmonary ossification might be a progressive disease, we should perform long-term follow-up.