Internal medicine
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Case Reports
Cervical spinal epidural abscess following acupuncture: successful treatment with antibiotics.
A 67-year-old man with poorly controlled diabetes mellitus (DM) had acupuncture several times a month for chronic shoulder muscle stiffness. A few days after acupuncture in the posterior nuchal region, a low-grade fever and backache developed, and subacutely progressed. ⋯ Conservative treatment with antibiotics was effective and it was well documented by following serial MRIs. This case suggested that needle acupuncture should be avoided for immunocompromised subjects such as patients with poorly controlled DM.
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A mass of 8 cm in diameter was revealed in the right upper lung field of a 46-year-old female patient. The chest X-ray film taken one year previously revealed only a linear shadow in the same position, which was thought to be a vacant cyst. ⋯ Pathologically, the cyst wall was lined with bronchial epithelium with no evidence of malignancy. Immunohistochemical study revealed CA19-9 positivity in the bronchial epithelium of the cyst wall.
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Case Reports
Secondary aortoduodenal fistula complicating aortic grafting, as a cause of intermittent chronic intestinal bleeding.
Intermittent intestinal bleeding persisted in a 77-year-old male, who had undergone grafting for abdominal aortic aneurysm. Each attack lasted for a few weeks and spontaneously resolved. ⋯ Autopsy revealed an adhesion area with a small fistula formation between the duodenum and aorta. Even slight endoscopic findings should be considered suggestive of aortoenteric fistula in patients after aortic surgery.
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To examine the clinical efficacy of a newly developed pressure swing adsorption (PSA) type oxygen concentrator with a membrane humidifier without added water for humidification, the new machine was compared with the conventional PSA type oxygen concentrator with bubble water humidifier in 10 patients with chronic pulmonary disease. Relative humidity, partial pressure of oxygen (PaO2) and partial pressure of carbon dioxide (PaCO2) in arterial blood were measured when the patient breathed air and oxygen from the oxygen concentrators. ⋯ Sufficient relative humidity (above 50%) of oxygen flow was obtained by using membrane humidifier. Since this machine saves the troublesome procedures of cleaning the container and changing the water, it will be beneficial to the patients who use a PSA-type oxygen concentrator in their home.
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Case Reports
Sensory conduction study of cisplatin neuropathy: preservation of small myelinated fibers.
We report a patient with peripheral neuropathy caused by cisplatin for the treatment of testicular tumor. Routine studies of nerve conduction and somatosensory evoked potentials demonstrated large myelinated fiber neuropathy suggesting ganglioneuronopathy. We also performed a CO2 laser evoked potential study, and found that small myelinated fibers, which are related to pain sensation, were well preserved in this patient.